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Time to move from serum creatinine to eGFR

There have been many controversies about the definition or significance of the ‘metabolic syndrome’, which is intended to identify the presence of multiple risk factors for cardiovascular disease (CVD). In September 2005, the American Heart Association (AHA) and the American Diabetes Association (ADA) issued conflicting statements [1,2]. The ADA suggested that more research is needed to clarify the relationships between the metabolic syndrome and CVD events [1], while the AHA forged ahead with guidelines to define, diagnose and treat the syndrome as a distinct condition [2,3]. The metabolic syndrome is based on the hypothesis that CVD and Type 2 diabetes may share some risk factors which cluster, and the main common pathogenic underlying mechanism is considered to be insulin resistance [1]. In July 2006, ADA and AHA issued a statement introducing the term ‘cardiometabolic risk’ to designate the risks of diabetes and CVD [4]. The concept of ‘cardiometabolic risk’ is, like that of the metabolic syndrome, derived from the hypothesis that diabetes and CVD share risk factors [4], which are often referred to as ‘common soil’ [5]. It is, however, obvious that there are several risk factors, such as low-density lipoprotein (LDL) cholesterol, which are responsible for the CVD events but which are not related to insulin resistance [6]. Furthermore, there are several risk factors which contribute to the development of Type 2 diabetes which are unrelated to insulin resistance. Of particular interest is that, as suggested by one of us (YS) [7], Type 2 diabetes in the Japanese population is very different from that of Caucasians, in that the former is predominantly associated with insulin deficiency while the latter is mostly associated with insulin resistance [8,9]. The significance of insulin deficiency in the development of Japanese Type 2 diabetes is supported by our previous reports [8,10,11] using techniques such as the minimal model approach [12]. In this context, the term ‘cardiometabolic risk’ is as confusing as the ‘metabolic syndrome’ in clarifying the pathogenesis of diabetes mellitus particularly in Asian populations.