Atlanta, Ga—The constellation of risk factors for cardiovascular disease—otherwise known as metabolic syndrome (Met-S)—was the main topic of discussion and presentations for researchers at the recently held 21st Annual International Interdisciplinary Conference on Hypertension and Related Cardiovascular Risk Factors in Ethnic Populations. The meeting was sponsored by the International Society on Hypertension in Blacks (ISHIB) and the American Society of Hypertension.
Metabolic syndrome scrutinized at annual meeting
The meeting focused on Met-S because this has become one of the most prominent disease entities across cardiovascular medicine, said Shawna Nesbitt, MD, MS, vice president of ISHIB, cochair of the scientific planning committee for the 2006 meeting, and associate professor in Internal Medicine at the University of Texas Southwestern Medical Center. Furthermore, cardiovascular disease is disproportionately represented among ethnic populations, so Met-S is a natural area of concern for the organization.
Although a firm definition for this condition remains elusive, there is no denying the seriousness of the individual components thought by many to comprise Met-S. Individually, abdominal obesity, dyslipidemia, insulin resistance, and high blood pressure can all have serious consequences, and the conference presentations reflected that. Plenary sessions and workshops discussed the connections between Met-S and diabetes, chronic kidney disease, and stroke, and abstracts presented during poster sessions delved further into particular topics related to Met-S, such as salt sensitivity and lifestyle modifications, including transcendental meditation (TM). A number of presentations also discussed the alarming rise of Met-S in children and adolescents.
History tells us that the Roman emperor Nero fiddled while Rome burned. Does a similar situation exist in regard to Met-S? Does the lack of a firm definition for Met-S have the potential to sidetrack efforts to actually address the problem?
Metabolic syndrome: Controversy and context
According to Dr Nesbitt, this is unlikely. Despite a lack of firm agreement on a definition, physicians do recognize that the components of the syndrome come as a package. Although the lack of consensus may affect an overall treatment strategy, addressing the syndrome’s components—high cholesterol, hypertension, etc—is the basis of the approach. Dr Nesbitt cautioned, however, that addressing these components in isolation may leave the patient exposed to harm.
In addition, a Met-S entity is not something lay persons know of, and it is not something that patients necessarily need to be educated about. “Patients barely grasp the concept of diabetes, what it means, and how to take care of it,” said Dr Nesbitt. So for patients with diabetes, as well as conditions such as hypertension and high cholesterol, it may be enough to treat these diseases and try to alert patients of the potentially magnifying effect of one condition on the next. To this end, it is incumbent on the physician to communicate effectively with the patient, Dr Nesbitt advised.
Recent studies have pointed out the rise of obesity and Met-S in the general US population. But what may be most disturbing is the expansion of these conditions in younger age groups. Elizabeth B. Rappaport, MD, provided an overview of the situation at a meeting workshop, noting that studies from 2003 and 2004 showed that the overall prevalence of Met-S rose from approximately 4% to 6.4% between 1988-1994 and 1999-2000. Using currently available data, she also estimated that 11 million children and adolescents are obese; as many as 2 million may already have hypertension; and perhaps 3 million may have Met-S. Dr Rappaport also pointed out that Mexican-American adolescents have consistently suffered from higher rates of the syndrome.
Children and changing behaviors
Because treating these conditions is largely a matter of behavioral changes, individual physicians and public health professionals may be stymied as to how to proceed. Dr Rappaport noted that “the underlying causes of obesity far transcend the ability of the medical care system to address it in a clinical setting. Physicians looking after children and adolescents should, of course, identify those who have elements of the metabolic syndrome, and elevated blood pressure is common and easy to measure. Unfortunately, changing dietary habits and increasing physical activity are not easy to do as they are strongly affected by the environment in which children live, play, and attend school.”
Although there has been some backlash against the practice, many school districts continue to negotiate contracts with beverage suppliers who provide children ready access to sweetened drinks. Dr Rappaport noted that it is not just physicians but adults who “must guide children and regulate those environments in ways that favor healthy eating in healthy physical activity.” Going beyond the purview of traditional medicine, Dr Rappaport points out that “advocacy to improve school funding so that schools will be less dependent on sales of sugar-sweetened beverages and high-fat, high-calorie snack foods in school cafeterias and vending machines” is what is really required to battle obesity among children.
Research presented at the meeting echoed these points—that treating Met-S often involves behavioral changes, and these are difficult to implement medically.
New research in the metabolic syndrome
The connection between salt intake and hypertension has long been known, but as understanding of Met-S grows, so too does the understanding of the salt—Met-S connection. In a study of 290 subjects with Met-S, Luigi Cubeddu, MD, PhD, of Nova Southeastern University College of Pharmacy, found that salt sensitivity was markedly increased in subjects with Met-S. Study subjects who had more of the defining traits of Met-S (ie, abdominal obesity, high blood pressure, dyslipidemia, etc) had a greater reduction in blood pressure when salt intake was reduced, compared with subjects who had fewer traits of the syndrome.
In another study presented at the meeting, researchers from Maharishi University (Fairfield, Iowa), Howard University Hospital (Washington, DC), and Morehouse School of Medicine (Atlanta, Ga) reported on results comparing the use of TM and a health education program over 1 year. The TM group practiced meditation for 20 minutes twice a day, while the health education group received detailed information on risk factors for heart disease and stroke, exercise training, and extensive instructions on selecting and preparing health foods. Both groups showed improvements in clinical indicators including blood pressure, triglycerides, and fasting glucose.
Since its founding in 1986, the ISHIB has worked to stimulate research, reduce hypertension among ethnic minorities, and promote public awareness of the harmful effects of hypertension and related risk factors. That approach will continue in the years ahead, as incoming president Kenneth A. Jamerson, MD, has promised an aggressive approach to managing health care disparities that will feature measurable results and impact.
Information from the 21st Annual Conference will be collated in a clinical update, which will be published shortly by ISHIB. Copies can be requested by contacting the program manager (404-880-0343) at ISHIB or visiting the Web site (
). The 22nd Annual conference will be held in Orlando, Fla, June 22-24, 2007.
Ethnicity & Disease, the official journal of the society, is a key means for getting information out to health care professionals. The journal is now 16 years old and is indexed on MEDLINE.