THE METABOLIC SYNDROME - OVEREATING, INACTIVITY, POOR COMPLIANCE OR DUD ADVICE

Death from myocardial infarction was a rare clinical entity at the beg inning of this century, but with an ageing population it is poised to become the most common cause of death worldwide.(1) Ample epidemiologi cal evidence confirms the clinical impression that cardiovascular risk factors-hypertension, glucose intolerance, dyslipidaemia, obesity-ten d to 'cluster' in individual patients.(2) This metabolic syndrome, or 'Syndrome X', which is thought to be underpinned by decreased insulin sensitivity, was first described in 1966 by Camus(3) and popularized b y Reaven in 1988.(4) The enthusiasm and interest generated have led to the elucidation of some details concerning the pathogenesis of insuli n resistance and coronary artery disease but have done little to chang e treatments or outcomes. Meanwhile, a global epidemic of Type 2 diabe tes mellitus is said to be on the horizon(5) and it has been calculate d that by the year 2230, 100 % of the adult United States population w ill be obese.(6) (C) 1998 John Wiley & Sons, Ltd.