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To the Editor: In their prospective cohort study, Dr Lakka and colleagues¹ found that men with the metabolic syndrome were at greater risk of cardiovascular disease (CVD) and all-cause mortality, even if they did not have CVD or diabetes at baseline. Further analyses are required, however, before the real prognostic value of the metabolic syndrome can be assessed.

A central issue is what is gained and what is lost by categorizing individuals as having the metabolic syndrome compared with assessing their risks on the basis of combinations of individual risk factors. Although low-density lipoprotein cholesterol, smoking, and family history of coronary heart disease (CHD) were controlled for in the analyses, low levels of high-density lipoprotein cholesterol and hypertension (both included in the definition of the metabolic syndrome) are also established risk factors for CVD. Although the authors excluded from one of their analyses participants with impaired fasting glucose levels, this . . . [Full Text of this Article]

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