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Volume 357:98 July 5, 2007 Number 1

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Metabolic Syndrome and Cardiovascular Disease: Epidemiology, Assessment, and Management

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Edited by Andrew J. Krentz and Nathan D. Wong. 313 pp., illustrated. New York, Informa Healthcare, 2007. $169.95. ISBN 978-0-8493-9373-0.

Few topics in medicine are as controversial as the metabolic syndrome. Criticism of the term “syndrome,” the lack of standardized methodology in the construction of diagnostic criteria proposed by different organizations, the debate about the role of obesity and insulin resistance, and discrepancies as to when and how the syndrome should be treated are among the arguments surrounding this topic. Metabolic Syndrome and Cardiovascular Disease provides information on these and other matters in an attractive way, introducing readers to the controversy. The book is entirely accessible, easy to read, and supplemented by summaries emphasizing the most important aspects of each chapter.

In their selection of essays, the editors stress that the question of the correctness of calling a cluster of metabolic risk factors a “syndrome” is merely a semantic one, and they focus on the two general categories of causation of the syndrome: insulin resistance and obesity. In this way, the editors elegantly shut down the debate over the term “syndrome.”

The book presents epidemiologic data and explains the various definitions of the metabolic syndrome, emphasizing the practical clinical use of the term to identify people with a high risk of cardiovascular disease and diabetes. The diverse diagnostic criteria are treated amply and in such a way that the authors always maintain an impartial position, thereby allowing readers to come to their own conclusions.

Later chapters in the book discuss the causes of the metabolic syndrome, including information about the influence of obesity and insulin as well as family history, sex, age, and physical inactivity — none of which are included in current definitions of the syndrome. In addition, the authors discuss the mechanisms implicated in the acceleration of atherogenesis, as well as the roles of endothelial dysfunction, oxidative stress, and inflammation as part of the risk for vascular events.

Also discussed is the considerable challenge that the metabolic syndrome presents to health care professionals involved in preventive medicine. The book criticizes the traditional medical curriculum that gives priority to the treatment of acute and subacute diseases but assigns little or no importance to the management of chronic diseases and the care of outpatients. Thus, the failure of doctors to intervene pharmacologically and, perhaps more important, with regard to patients' lifestyles, is blamed on inadequacies in medical education. In this context, the book includes an attractive chapter on nutrition and physical activity and focuses on the need for changes in lifestyle as the most important aspect of the management of the metabolic syndrome.

This well-written book is essential reading for clinicians and medical students who want to understand the nature of the metabolic syndrome as well as its prevention and treatment.