Recent reports issued by the American Diabetes Association (ADA) and other organizations have raised questions about the metabolic syndrome as a clinical category. This has led some to infer that those organizations were also questioning the role of identifying and treating risk factors for cardiovascular disease (CVD) and diabetes. To dispel such suggestions, the ADA and the American Heart Association (AHA) have now issued a joint “call for action” (Diabetes care. 2006; 29:1697-1699; Circulation. 2006; 113:2943-2946), reiterating the commitment of both organizations to the prevention of these conditions and calling upon physicians to increase their prevention efforts in light of the growing burden of the overweight/obesity epidemic.   

While advancements in medicine have led to a steady decline in heart disease and stroke, the prevalence of diabetes has skyrocketed, increasing from 4.9% in 1990 to 7% today. The driving force behind this is the almost two thirds of overweight/obese adult Americans.

It has long been known that the leading cause of death in patients with diabetes is CVD, which is also responsible for the lion’s share of morbidity. Compared with individuals without diabetes, those with diabetes are at a 2 to 4 times higher risk of developing CVD. They are also more likely to have hypertension and dyslipidemia. It was observations such as these that led researchers to suggest that metabolic abnormalities can cluster in individual patients, thus giving birth to the term “metabolic syndrome.”

The ADA and AHA reemphasize the importance of identifying and modifying the core set of risk factors — prediabetes, hypertension, dyslipidemia, and obesity. They urge patients to quit smoking and call upon physicians to focus on assessing patient risk and on adhering to the national guidelines aimed at preventing and treating these conditions.

Although various algorithms are available for assessing patients’ risk for diabetes, they are woefully underused in clinical practice, according to the 2 organizations. They also call on physicians to use a diagnostic tool that has been well validated in clinical trials and is freely available online at www.diabetes.org/diabetesphd.

This Diabetes PHD (Personal Health Decisions) tool calculates a person’s risk for diabetes, heart attack, stroke, kidney failure, and complications of diabetes. It also gives patients the opportunity to see the effects that changes in their lifestyle would have on their future health. 

Even without such tools, the ADA/ AHA reminds physicians that they can quickly assess a patient’s global risk for diabetes or CVD by measuring serum glucose, blood pressure (BP), and low-density lipoprotein cholesterol concentration; asking about smoking; and noting whether the patient is obese.

Patients with overt disease usually require drug treatment. But when diabetes and CVD are identified in their early stages, lifestyle modification may be enough. Lifestyle modification has been demonstrated to substantially reduce the risk of progression to type 2 diabetes. Weight loss of as little as 7% over 12 months and regular, moderate physical activity have proven, dramatic effects on all cardiometabolic risk factors.

That some scientific issues remain unresolved does not change the fact that the relationship between various cardiometabolic risk factors and diabetes and CVD has been unequivocally established.

According to the ADA/AHA, the countless years of work devoted to preventing and controlling chronic disease can be undermined if physicians do not wake up to the fact that overweight and obesity are not merely cosmetic problems. They are blaring signs of underlying risk factors that must be addressed.