Metabolic syndrome: definition, pathophysiology, and mechanisms.

In 1988, Reaven proposed that insulin resistance is central to the etiology of type 2 diabetes mellitus, hypertension, and coronary artery disease. The concept of insulin resistance and associated metabolic abnormalities leading to increased risk of cardiovascular disease became known by a variety of names, including metabolic syndrome, dysmetabolic syndrome, syndrome X, cardiometabolic syndrome, and insulin resistance syndrome. Today, metabolic syndrome is a matter of immense public concern for atherosclerosis prevention. The syndrome may affect more than 50% of the elderly in the United States and even higher percentages in various ethnic groups around the world. Its prevalence continues to rise, probably as a result of increasing obesity in the United States and elsewhere. In April 2002, a conference on bThe Metabolic Syndrome of Cardiovascular Risk and Insulin ResistanceQ was held in Washington, DC. This is the first of 2 papers summarizing the discussion at that conference. This paper will address the definition of metabolic syndrome, the components of the syndrome, and the underlying pathophysiology. The second paper will address atherogenesis and therapeutic targets, as well as the design of future studies and clinical trials.