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Point: the metabolic syndrome still lives.

Dr. Gerald Reaven’s report (1) of the death of the metabolic syndrome may be exaggerated. Whether his obituary relates specifically to the National Cholesterol Education Program’s Adult Treatment Panel III (ATP III) (2) definition of metabolic syndrome or to all attempts at making a clinical definition of the metabolic syndrome is unclear. Regardless, he does a thorough autopsy on the ATP III report and appears to find widespread systemic disease. After reading his postmortem examination, however, one wonders whether he is reporting on the death of the syndrome or rather is dissecting it while it is still alive. The editors of Clinical Chemistry have given me a last chance to resuscitate what appears to be a badly mangled body. In my examination of the corpus, however, I see signs of life. Thanks to advances of modern medicine, it may be possible achieve survival. This is my assigned task.

Of interest is the fact that Dr. Reaven’s sharp blade cuts only into the ATP III definition of the metabolic syndrome. Other definitions escape his knife, specifically those of the WHO (3), the European Group on Insulin Resistance (EGIR) (4), and the American Association of Clinical Endocrinologists (AACE) (5). The definitions put forward by these organizations are similar to those of ATP III, but apparently Dr. Reaven believes that the ATP III is the most flawed of the group. Because I was a member of the team that issued the ATP III criteria, perhaps I can offer a rationale for having done so. Several points can be made in their defense.

In 1993, the ATP II report (6) placed increased emphasis on management of obesity to reduce risk for atherosclerotic cardiovascular disease (ASCVD). This emphasis was not widely adopted by practicing physicians, and by all accounts, the problem of obesity in the …