The term “metabolic syndrome” denotes a clustering of traditional and emerging
risk factors for atherothrombotic cardiovascular disease. Moreover, individuals
who satisfy the current diagnostic criteria that define the syndrome are also at
substantially increased risk of developing Type 2 diabetes—itself a coronary
heart disease risk equivalent. Central obesity and insulin resistance are core features of the syndrome, which has come to be recognized as a major global threat
to vascular health in the 21st century. The time is optimal for a textbook dedicated
to this important issue.
The metabolic syndrome has adverse implications for many aspects of vascular function ranging from endothelial function, the microvascular tree,
medium-sized arteries, and large conduit vessels. Furthermore, gathering evidence suggests that interactions between small and large vessel disease may be
more important than perhaps has previously been appreciated.
There are fears that the successes in reducing cardiovascular mortality in
recent decades may soon be reversed. Fueled by the explosion of obesity, the
syndrome is characterized by the clustering of classic and emerging risk factors
for cardiovascular disease. No longer is it appropriate to regard obesity, glucose
intolerance and diabetes, hypertension, and dyslipidemia as separate entities to
be treated in individual clinical settings (e.g. the diabetes clinic, hypertension
clinic, etc.). If one of the components of the metabolic syndrome is discovered,
then steps should be taken to determine whether others are also present, and for
implementing comprehensive approaches aimed toward treating the constellation of metabolic risk factors. This can be accomplished by simple clinical and
biochemical tests and a multidisciplinary team approach implementing lifestyle
and pharmacologic treatment.
This new paradigm presents challenges for clinicians involved in the
assessment and management of individuals with metabolic syndrome. This
rapidly moving area is being driven by advances in clinical and basic science.
The latter are informing strategies for risk stratification and optimization of
nonpharmacologic and drug-based treatment.
Our objective in bringing this book into print has been to present a stateof-the-art account of the salient issues for a clinically-oriented readership. In this
endeavor, we are pleased to have been joined by an international team of experts,
each recognized in his or her field. Various chapters cover epidemiology, diagnosis, risk assessment, vascular biology, lifestyle measure, management of
hyperglycemia, dyslipidemia, and hypertension, and strategies for maximizing
compliance to treatment recommendations. We hope that the book will not only
be of academic interest but will provide helpful practical guidance to primary
care physicians, diabetologists, cardiologists, dietitians, and other healthcare
professionals involved in the prevention and treatment of vascular disease.
A better understanding of the mechanisms that cause cardiovascular risk factors to cluster together to the long-term detriment of so many individuals should
facilitate more effective measures for prevention and treatment. Scientists working
in epidemiology, basic science, drug discovery, and clinical trials each have roles
to play in unraveling what is proving to be a major public health crisis.
It has been a pleasure working with colleagues from around the world and
with the staff of Informa Healthcare. We welcome feedback from readers in the
expectation that the text will require updating in the future, given the rapidly
increasing scientific knowledge and developments in the field.