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Cited by 11,961Diabetes, Cardiovascular Risks, and LipoproteinsCardiovascular Function and Risk FactorsDiet, Metabolism, and Disease

Diagnosis and Management of the Metabolic Syndrome: An American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement

Open access
Grundy, Scott M., Cleeman, James I., Daniels, Stephen R., Donato, Karen A., Eckel, Robert H., Franklin, Barry A., Gordon, David J., Krauss, Ronald M. +4 more·2005·Circulation
DOI 10.1161/circulationaha.105.169404
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Abstract

The American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a

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Written from the paper’s full text.

TL;DR

This AHA/NHLBI scientific statement defines the metabolic syndrome as a constellation of interrelated metabolic risk factors that increase risk for atherosclerotic cardiovascular disease and type 2 diabetes, and it recommends retaining the ATP III diagnostic criteria with minor modification. It emphasizes lifestyle management of underlying risk factors—abdominal obesity, physical inactivity, and atherogenic diet—with drug therapy directed primarily at LDL-C, blood pressure, and glucose when indicated.

Key findings

  • The statement adopts ATP III criteria: diagnosis requires any 3 of 5 factors—elevated waist circumference (≥102 cm in men, ≥88 cm in women), triglycerides ≥150 mg/dL or drug treatment, HDL-C <40 mg/dL in men or <50 mg/dL in women or drug treatment, blood pressure ≥130/85 mm Hg or antihypertensive treatment, and fasting glucose ≥100 mg/dL or drug treatment.
  • The only major modification from ATP III is lowering the impaired fasting glucose threshold from 110 to 100 mg/dL, corresponding to updated ADA criteria.
  • Management prioritizes lifestyle: weight loss of about 7% to 10% from baseline over 6 to 12 months, caloric reduction of 500 to 1000 calories/day, and at least 30 minutes of moderate-intensity activity most days, preferably ≥60 minutes 5 days/week or daily.
  • Lipid therapy targets LDL-C first; after LDL-C goal is reached, non-HDL-C becomes secondary when triglycerides are ≥200 mg/dL, with non-HDL-C goals 30 mg/dL higher than LDL-C goals; blood pressure goals are <140/90 mm Hg, or <130/80 mm Hg with diabetes or chronic kidney disease, and diabetes glycemic goal is HbA1c <7.0%.

Methods

  • Design: an American Heart Association/National Heart, Lung, and Blood Institute scientific statement providing guidance for diagnosis and management of metabolic syndrome in adults.
  • Data/sample: no primary study sample; the statement reviews and synthesizes existing evidence and prior guideline documents, including WHO, EGIR, ATP III, AACE, and IDF criteria.
  • Main analysis: expert consensus comparison of diagnostic definitions and management recommendations, concluding that ATP III criteria remain simple and appropriate with minor modification rather than adopting the IDF requirement for abdominal obesity.

Limitations

  • The paper states that additional research is needed on long-term weight reduction and physical activity strategies, genetic and metabolic causes of the syndrome, short-term risk assessment tools, therapies for residual dyslipidemias, insulin resistance as a treatment target, proinflammatory mechanisms, and cost-effectiveness of drug therapies.
  • Evident from the text: this is a consensus scientific statement, not a systematic review or meta-analysis, and it reports no primary data, formal search strategy, or quantitative synthesis.
  • Evident from the text: recommendations rely heavily on existing NHLBI, AHA, and ADA guidelines and expert judgment, with several management questions noted as not adequately tested in randomized clinical trials.

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Registry

Crossref · 10.1161/circulationaha.105.169404

Cites

Statistics

Nothing to recompute.

Claims the paper makes

0 of 136 cited sources checked · 0 supported · 0 flagged

  • Premisenone given

    Insulin resistance predisposes to the hyperglycemia of type 2 diabetes mellitus.

    “There is no doubt that insulin resistance predisposes to the hyperglycemia of type 2 diabetes mellitus.”
    Quote in the paperSubstantial claim
  • Interpretationreasoning

    Whatever its cause, the metabolic syndrome identifies people at elevated risk for atherosclerotic cardiovascular disease.

    “Regardless of cause, the syndrome identifies individuals at an elevated risk for ASCVD.”
    Quote in the paperSubstantial claim
  • Premisecitation

    The metabolic syndrome is a group of interrelated metabolic risk factors that seem to directly promote atherosclerotic cardiovascular disease.

    “The metabolic syndrome is a constellation of interrelated risk factors of metabolic origin-metabolic risk factors-that appear to directly promote the development of atherosclerotic cardiovascular disease (ASCVD).”
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  • Interpretationreasoning

    The size of the increased atherosclerotic cardiovascular disease risk in metabolic syndrome varies with which components are present and with other non-metabolic-syndrome risk factors in the person.

    “The magnitude of the increased risk can vary according to which components of the syndrome are present plus the other, non-metabolic syndrome risk factors in a particular person.”
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  • Premisenone given

    Upper-body obesity correlates strongly with insulin resistance.

    “Upper-body obesity correlates strongly with insulin resistance.”
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  • Classified as probably not a substantial claim. 32
  • May combine two claims. 43

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    Premisenone given

    The most widely recognized metabolic risk factors are atherogenic dyslipidemia, elevated blood pressure, and elevated plasma glucose.

    “The most widely recognized of the metabolic risk factors are atherogenic dyslipidemia, elevated blood pressure, and elevated plasma glucose.”
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    Premisecitation

    The main underlying risk factors for the syndrome appear to be abdominal obesity and insulin resistance.

    “The predominant underlying risk factors for the syndrome appear to be abdominal obesity [2][3][4] and insulin resistance 5,6 ;”
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    Premisecitation

    Other conditions associated with the syndrome can include physical inactivity, aging, and hormonal imbalance.

    “other associated conditions can be physical inactivity, 3,7 aging, 8 and hormonal imbalance.9”
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    Premisecitation

    An atherogenic diet can increase cardiovascular disease risk in people with the syndrome, although it is not specifically listed as an underlying risk factor for the condition.

    “An atherogenic diet (eg, a diet rich in saturated fat and cholesterol) can enhance risk for developing cardiovascular disease in people with the syndrome, although this diet is not listed specifically as an underlying risk factor for the condition.1”
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    Premisereasoning

    Insulin-resistant individuals need not be clinically obese, but they commonly have an abnormal fat distribution with predominant upper-body fat.

    “Although insulin-resistant individuals need not be clinically obese, they nevertheless commonly have an abnormal fat distribution that is characterized by predominant upper body fat.”
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    Premisecitation

    Ectopic lipid accumulation in muscle and liver seemingly predisposes to insulin resistance and dyslipidemia.

    “Ectopic lipid accumulation in muscle and liver seemingly predisposes to insulin resistance 29 and dyslipidemia.30”
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    Premisecitation

    Upper-body obesity features an unusually high release of nonesterified fatty acids from adipose tissue, which contributes to lipid accumulation outside adipose tissue.

    “An interesting feature of upper-body obesity is an unusually high release of nonesterified fatty acids from adipose tissue 12,14,28 ; this contributes to accumulation of lipid in sites other than adipose tissue.”
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    Premisecitation

    Adipose tissue in obese people is insulin resistant, raising nonesterified fatty acid levels, worsening insulin resistance in muscle, and altering hepatic metabolism.

    “Adipose tissue in obese people is insulin resistant, which raises nonesterified fatty acid levels, worsening insulin resistance in muscle 29,33 and altering hepatic metabolism 31 ;”
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    Interpretationreasoning

    The metabolic syndrome is a syndrome, a grouping of atherosclerotic cardiovascular disease risk factors, and probably has more than one cause.

    “Available data suggest that it truly is a syndrome, ie, a grouping of ASCVD risk factors, but one that probably has more than one cause.”
    Quote in the paperSubstantial claim

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    Premisecitation

    These adipokine changes include increased production of inflammatory cytokines, plasminogen activator inhibitor-1, and other bioactive products, while the protective adipokine adiponectin is reduced.

    “These include increased production of inflammatory cytokines, 35,36 plasminogen activator inhibitor-1, 37 and other bioactive products 38 -40 ; at the same time the potentially protective adipokine, adiponectin, is reduced.41,42”
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    Premisecitation

    In obesity, adipose tissue produces excess cytokines while adiponectin output is diminished, and these responses appear to strengthen the connection between obesity and inflammation.

    “In the presence of obesity, adipose tissue indeed produces cytokines in excess, whereas output of adiponectin is diminished; these responses appear to heighten the connection between obesity and inflammation.35”
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    Premisecitation

    The US population varies considerably in degree of insulin resistance; those with more inherent insulin resistance can develop the metabolic syndrome with only moderate excess abdominal fat, while even people with little or no inherent insulin resistance can develop it if they accumulate marked abdominal obesity.

    “Moreover, the population of the United States varies considerably in degree of insulin resistance 46 ; those having more inherent insulin resistance can develop the metabolic syndrome with only moderate excess in abdominal fat, 43,44 but even people with little or no inherent insulin resistance can develop the metabolic syndrome if they accumulate marked abdominal obesity.3,8”
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    Premisecitation

    The metabolic syndrome is associated with greater risk for cardiovascular disease, but once type 2 diabetes mellitus emerges, cardiovascular risk increases even more.

    “Several recent reports show that the metabolic syndrome is associated with greater risk for cardiovascular disease, [63][64][65][66][67][68][69][70][71][72][73] but once type 2 diabetes mellitus emerges, cardiovascular risk increases even more.74”
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    Premisecitation

    Many South Asians appear to be inherently insulin resistant, and this condition is worsened by mild abdominal obesity.

    “Notable are many South Asians who appear to be inherently insulin resistant, 45 a condition that is exacerbated by mild abdominal obesity.14”
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    Premisereasoning

    The WHO group allowed the term metabolic syndrome to be used in patients with type 2 diabetes mellitus who otherwise met the requirements for the syndrome.

    “Importantly, the WHO group allowed the term metabolic syndrome to be used in patients with type 2 diabetes mellitus who otherwise met the requirements for the syndrome.”
    Quote in the paperNot a substantial claim

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    Premisereasoning

    The ATP III criteria required no single factor for diagnosis, but made the presence of three of five factors the basis for establishing the diagnosis.

    “The ATP III criteria thus required no single factor for diagnosis, but instead made the presence of 3 of 5 factors the basis for establishing the diagnosis; these were abdominal obesity (also highly correlated with insulin resistance), elevated triglycerides, reduced HDL-C, elevated blood pressure, and elevated fasting glucose (IFG or type 2 diabetes mellitus).”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    ATP III noted that some individuals having only two other metabolic syndrome criteria appear insulin resistant even when waist circumference is only marginally elevated, for example 94 to 101 cm in men or 80 to 87 cm in women.

    “Thus, ATP III specifically noted that some individuals having only 2 other metabolic syndrome criteria appear to be insulin resistant even when the waist circumference is only marginally elevated, eg, 94 to 101 cm in men or 80 to 87 cm in women.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    In 2001, ATP III introduced alternative clinical criteria for defining the metabolic syndrome, with the purpose of identifying people at higher long-term risk for ASCVD who deserved clinical lifestyle intervention.

    “In 2001, the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) introduced alternative clinical criteria for defining the metabolic syndrome.1 In so doing, the purpose of ATP III was to identify people at higher long-term risk for ASCVD who deserved clinical lifestyle intervention to reduce risk.”
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    Premisereasoning

    EGIR focused more on abdominal obesity than WHO did, but excluded patients with type 2 diabetes mellitus from their syndrome because insulin resistance was viewed primarily as a risk factor for diabetes.

    “Notably, EGIR focused more on abdominal obesity than did WHO, but in contrast to WHO, EGIR excluded patients with type 2 diabetes mellitus from their syndrome because insulin resistance was viewed primarily as a risk factor for diabetes.”
    Quote in the paperNot a substantial claim

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    Premisecitation

    The WHO 1998 consultation group emphasized insulin resistance as the major underlying risk factor and required evidence of insulin resistance for diagnosis.

    “The first proposal came in 1998 from a consultation group on the definition of diabetes for the World Health Organization (WHO).106 This group emphasized insulin resistance as the major underlying risk factor and required evidence of insulin resistance for diagnosis.”
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    Interpretationreasoning

    The metabolic syndrome is a syndrome and not a defined uniform entity; no single pathogenesis has been elucidated, and one may not exist.

    “Although the metabolic syndrome is often referred to as a discrete entity, it is important to recognize, as noted earlier, that it is a syndrome and not a defined uniform entity.No single pathogenesis has been elucidated, nor may one exist.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Premisereasoning

    The IDF clinical definition makes the presence of abdominal obesity necessary for diagnosis; when it is present, two additional factors originally listed in ATP III are sufficient for diagnosis.

    “The IDF clinical definition thus makes the presence of abdominal obesity necessary for diagnosis.When such is present, 2 additional factors originally listed in the ATP III definition are sufficient for diagnosis.”
    Quote in the paperSubstantial claim

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    Premisereasoning

    IDF specified abdominal obesity thresholds by nationality or ethnicity based on the best available population estimates.

    “IDF recognized and emphasized ethnic differences in the correlation between abdominal obesity and other metabolic syndrome risk factors.For this reason, criteria of abdominal obesity were specified by nationality or ethnicity based on best available population estimates.”
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    Premisereasoning

    By EGIR criteria, plasma insulin levels in the upper quartile of the population defined insulin resistance; elevated plasma insulin plus two other factors constituted a diagnosis of the insulin-resistance syndrome.

    “By their criteria, plasma insulin levels in the upper quartile of the population defined insulin resistance.An elevated plasma insulin plus 2 other factors-abdominal obesity, hypertension, elevated triglycerides or reduced HDL-C, and elevated plasma glucose-constituted a diagnosis of the insulin-resistance syndrome.”
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    Premisereasoning

    A diagnosis by WHO criteria could be made when a patient exhibited one of several markers of insulin resistance plus two additional risk factors.

    “A diagnosis of the syndrome by WHO criteria could thus be made when a patient exhibited one of several markers of insulin resistance plus 2 additional risk factors.”
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    Premisenone given

    Direct measures of insulin resistance are laborious and not well standardized, and less-specific measures such as glucose tolerance tests are not routinely used in clinical practice.

    “It was noted that direct measures of insulin resistance are laborious and not well standardized.Moreover, less-specific measures, such as glucose tolerance tests, are not routinely used in clinical practice.”
    Quote in the paperSubstantial claim

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    Premisecitation

    Elevated apoB-containing lipoproteins, low HDL-C levels, and hypertension are well-established major risk factors.

    “Indeed, 3 of the metabolic risk factors-elevated apoB-containing lipoproteins, 1 low HDL-C levels, 1 and hypertension 91 -are well established, major risk factors.”
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    By the AACE definition, once a person develops type 2 diabetes mellitus, the term insulin resistance syndrome no longer applies.

    “By the AACE's definition, once a person develops type 2 diabetes mellitus, the term insulin resistance syndrome no longer applies.”
    Quote in the paperNot a substantial claim

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    Premisereasoning

    ATP III espoused the position that abdominal obesity is an important underlying risk factor for the syndrome.

    “Although ATP III did not make any single risk factor (eg, abdominal obesity) a requirement for diagnosis, it nonetheless espoused the position that abdominal obesity is an important underlying risk factor for the syndrome.”
    Quote in the paperNot a substantial claim

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    Interpretationreasoning

    From a clinical standpoint, the presence of the metabolic syndrome identifies a person at increased risk for ASCVD and/or type 2 diabetes mellitus.

    “From a clinical standpoint, presence of the metabolic syndrome identifies a person at increased risk for ASCVD and/or type 2 diabetes mellitus.”
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    Premisenone given

    These cutpoints identify approximately the upper quartile of the US population.

    “These cutpoints identify approximately the upper quartile of the US population.”
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    Premisecitation

    A large number of studies have evaluated the ATP III criteria for the metabolic syndrome, and the majority of these reports support the present structure of the ATP III criteria.

    “In addition, a large number of studies have been carried out to evaluate the ATP III criteria for the metabolic syndrome.35, The majority of these reports are supportive of the present structure of ATP III criteria.”
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    Interpretationreasoning

    People with fasting glucose of 100 to 110 mg/dL are now classified as having IFG, and many of them would have IGT if tested by OGTT.

    “People who have fasting glucose in the range of 100 to 110 mg/dL are now said to have IFG; many such people would have IGT if tested by OGTT.”
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    Interpretationnone given

    Effective lifestyle change will reduce all of the metabolic risk factors.

    “Effective lifestyle change will reduce all of the metabolic risk factors.”
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    Interpretationcitation

    Keeping a lower weight is just as important as losing weight.

    “Maintenance of a lower weight is just as important; this requires long-term follow-up and monitoring.108”
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    Premisecitation

    More physical activity aids weight reduction, improves metabolic risk factors, and lowers overall ASCVD risk.

    “Increasing physical activity assists in weight reduction; it also has beneficial effects on metabolic risk factors; and importantly, it reduces overall ASCVD risk.147”
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    More physical activity helps increase the calorie deficit.

    “Greater physical activity helps to enhance caloric deficit.”
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    Interpretationnone given

    Weight-loss surgery carries risk.

    “Weight-loss surgery is not without risk, however.”
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    Current AHA guidelines advise clinical assessment of future ASCVD risk before starting a new exercise regimen.

    “Current AHA guidelines 143 call for clinical assessment of risk for future ASCVD events before initiating a new exercise regimen.”
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    Weight-loss drugs may be helpful for some patients.

    “Nevertheless, in some patients they may be helpful.”
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    Interpretationnone given

    People at high risk for obesity complications may benefit from bariatric surgery.

    “Individuals at high risk for the complications of obesity may benefit.”
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    Premisecitation

    The threshold for impaired fasting glucose was reduced from 110 to 100 mg/dL, corresponding to the recently modified American Diabetes Association criteria for impaired fasting glucose.

    “It must be noted in Table 2, however, that the threshold for IFG was reduced from 110 to 100 mg/dL; this adjustment corresponds to the recently modified American Diabetes Association (ADA) criteria for IFG.134”
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    Interpretationreasoning

    Abdominal obesity, triglycerides, and fasting glucose matter over the longer term.

    “These factors come into play in the longer term.”
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    Premisecitation

    Public recommendations advise accumulating at least 30 minutes of moderate-intensity exercise, such as brisk walking, on most or preferably all days.

    “Current recommendations for the public call for accumulation of Ն30 minutes of moderate-intensity exercise, such as brisk walking, on most, and preferably all, days of the week 77,143”
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    Interpretationreasoning

    Continuity with the original ATP III definition is appropriate in the absence of new evidence to the contrary.

    “Otherwise, the statement maintains that continuity with the original ATP III definition, which has been widely adopted in the United States and elsewhere, is appropriate in the absence of new evidence to the contrary.”
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    Premisenone given

    Individuals who have established ASCVD and/or diabetes can still have the metabolic syndrome.

    “It is important to note that individuals who have established ASCVD and/or diabetes can still have the metabolic syndrome.”
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    Interpretationnone given

    Self-monitoring physical activity can improve adherence to an activity program.

    “Self-monitoring of physical activity can help to achieve adherence to an activity program.”
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    Interpretationcitation

    At least 60 minutes of continuous or intermittent aerobic activity, preferably daily, promotes weight loss or weight maintenance.

    “Sixty minutes or more of continuous or intermittent aerobic activity, preferably done every day, will promote weight loss or weight-loss maintenance.”
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    Interpretationcitation

    When fat intake falls below 25% of calories, triglycerides may increase and HDL-C may decrease, so very-low-fat diets can worsen atherogenic dyslipidemia.

    “On the other hand, if the fat content falls below 25%, triglycerides can rise and HDL-C levels can decline 152 ; thus, very-low-fat diets may exacerbate atherogenic dyslipidemia.”
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    Interpretationnone given

    The cost-effectiveness and long-term safety of metformin and thiazolidinediones have not been documented.

    “Moreover, neither metformin nor thiazolidinediones are recommended in this statement solely for the purpose of preventing diabetes because their cost-effectiveness and long-term safety have not been documented.”
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    Premisecitation

    High-protein diets are poorly tolerated by people with chronic renal disease and markedly reduced glomerular filtration rate; excess protein raises phosphorus load, which can cause acidosis and worsen insulin resistance.

    “Highprotein diets of any sort are not well tolerated by individuals with chronic renal disease who have markedly reduced glomerular filtration rate; excess protein enhances phosphorus load, which can cause acidosis and worsen insulin resistance.155,156”
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  • May combine two claims.

    Premisecitation

    Fibrates and nicotinic acid lower non-HDL-C and are reported to reduce ASCVD risk in patients with metabolic syndrome or type 2 diabetes mellitus.

    “Both fibrates and nicotinic acid reduce non-HDL-C and reportedly decrease risk for ASCVD in patients with the metabolic syndrome/type 2 diabetes mellitus.[162][163][164]”
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    Interpretationnone given

    Effective weight loss needs calorie restriction, physical activity, and motivation; maintaining weight loss long term essentially requires balancing calorie intake and physical activity.

    “Effective weight loss requires a combination of caloric restriction, physical activity, and motivation; effective lifelong maintenance of weight loss essentially requires a balance between caloric intake and physical activity.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationnone given

    High-fat diets tend to be higher in saturated fat and often lack fruits, vegetables, and whole grains, which are important in recommended diets.

    “High-fat diets not only tend to be higher in saturated fat but they often are deficient in fruits, vegetables, and whole grains-all of which are important components in currently recommended diets.”
    Quote in the paperNot a substantial claim

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    Premisecitation

    Elevated total apoB is a related potential secondary target; it reflects the number of atherogenic lipoproteins in circulation.

    “A related and potential secondary target is an elevated total apoB 158 ; this measure denotes the number of atherogenic lipoproteins in circulation.”
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    Interpretationcitation

    The benefits of therapy extend to patients with type 2 diabetes whose blood pressure is above goal, and presumably to hypertensive patients with metabolic syndrome.

    “The benefits of therapy extend to patients with type 2 diabetes mellitus whose blood pressure is above goal level, and presumably to hypertensive patients with the metabolic syndrome.”
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    Interpretationnone given

    Non-HDL-C goals mirror LDL-C goals but are 30 mg/dL higher.

    “Goals for non-HDL-C parallel those for LDL-C except that the former are 30 mg/dL higher (Table 3).”
    Quote in the paperSubstantial claim

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    Premisecitation

    Statins lower both LDL-C and non-HDL-C by a similar percentage and reduce ASCVD event risk in patients with metabolic syndrome.

    “For example, statins lower both LDL-C and non-HDL-C by a similar percentage; moreover, statins reduce risk for ASCVD events in patients with the metabolic syndrome.161”
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    A large clinical trial raised the possibility that diuretics in patients with IFG or IGT may increase progression to type 2 diabetes, although diuretics do lower cardiovascular event risk.

    “The results of a large clinical trial 173 raised the possibility that use of diuretics in patients with IFG or IGT may increase the likelihood of progression to type 2 diabetes mellitus, although diuretics do in fact lower the risk for cardiovascular events.91,173”
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      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    Not all individuals starting a moderately progressive moderate-intensity exercise program need an exercise stress test.

    “It is not necessary, however, that all individuals beginning an exercise program of moderate intensity that is moderately progressive undergo an exercise stress test, although this issue remains controversial.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Glycemic control to hemoglobin A1c below 7% reduces microvascular complications and may also lower macrovascular disease risk.

    “Glycemic control to a hemoglobin A 1c of Ͻ7% reduces microvascular complications and may decrease risk for macrovascular disease as well.182”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [182]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    Differences in the components of the metabolic syndrome are even larger across racial and ethnic groups.

    “This variation is even greater among different racial and ethnic groups.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    These coagulation abnormalities are not routinely detected in clinical practice.

    “These abnormalities, however, are not routinely detected in clinical practice.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationreasoning

    Patients taking fibrates or nicotinic acid are presumed to have high triglycerides and low HDL-C.

    “Patients taking one of these drugs are presumed to have high TG and low HDL.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationnone given

    Some US adults of non-Asian origin with marginally increased waist circumference may have a strong genetic contribution to insulin resistance and should benefit from lifestyle changes, similar to men with categorical waist increases.

    “†Some US adults of non-Asian origin (eg, white, black, Hispanic) with marginally increased waist circumference (eg, 94 -101 cm [37-39 inches] in men and 80 -87 cm [31-34 inches] in women) may have strong genetic contribution to insulin resistance and should benefit from changes in lifestyle habits, similar to men with categorical increases in waist circumference.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Interpretationnone given

    The metabolic syndrome refers to a group of endogenous risk factors that raise the likelihood of developing both atherosclerotic cardiovascular disease and type 2 diabetes.

    “1.The metabolic syndrome is a term for a constellation of endogenous risk factors that increase the risk of developing both ASCVD and type 2 diabetes mellitus.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    A lower waist circumference cutpoint (at least 90 cm in men and at least 80 cm in women) appears appropriate for Asian Americans.

    “Lower waist circumference cutpoint (eg, Ն90 cm [35 inches] in men and Ն80 cm [31 inches] in women) appears to be appropriate for Asian Americans.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationnone given

    The efficacy of antiplatelet agents in people with type 2 diabetes without ASCVD has not been conclusively established in clinical trials, though they are widely recommended for such individuals.

    “Their efficacy in individuals with type 2 diabetes mellitus without ASCVD has not been established conclusively through clinical trials, although they are widely recommended in such individuals.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    For patients with established type 2 diabetes, clinical trials confirm that treating dyslipidemia and hypertension reduces cardiovascular risk.

    “For patients with established type 2 diabetes mellitus, clinical trials confirm a reduction in cardiovascular risk from treatment of dyslipidemia 161-163,179 -181 and hypertension.91”
    Quote in the paperSubstantial claim0 of 7 sources checked
    • cites [161]

      Not checked in the free run.

    • cites [162] source

      Not checked in the free run.

    • cites [163] source

      Not checked in the free run.

    • cites [179]

      Not checked in the free run.

    • cites [180] source

      Not checked in the free run.

    • cites [181] source

      Not checked in the free run.

    • cites [91] source

      Not checked in the free run.

69 of 69

  • The paper relies on this without support.

    IGT is more frequent than IFG and therefore identifies more people at increased diabetes risk.

    “IGT in fact exceeds IFG in frequency; it consequently uncovers more individuals at increased risk for diabetes.”

  • The paper relies on this without support.

    Metabolic syndrome rarely becomes clinically apparent without some degree of obesity and physical inactivity.

    “Although many people may be genetically susceptible to the metabolic syndrome, rarely does it become clinically manifested in the absence of some degree of obesity and physical inactivity.”

  • The paper relies on this without support.

    Currently available weight-loss drugs have limited usefulness in managing obesity.

    “Currently available weight-loss drugs possess limited utility in the management of obesity.”

  • The paper relies on this without support.

    Very high carbohydrate intake can worsen the dyslipidemia of metabolic syndrome.

    “Very high carbohydrate intakes can exacerbate the dyslipidemia of the metabolic syndrome.”

  • The paper relies on this without support.

    Fibrates and nicotinic acid both raise HDL-C and lower triglycerides and small LDL particles.

    “Both fibrates and nicotinic acid raise HDL-C as well as reduce triglycerides and small LDL particles.”

  • The paper relies on this without support.

    People with metabolic syndrome typically have elevated fibrinogen, plasminogen activator inhibitor-1, and other coagulation factors.

    “People with the metabolic syndrome typically manifest elevations of fibrinogen, plasminogen activator inhibitor-1, and other coagulation factors.”

  • The paper relies on this without support.

    For primary prevention, the only long-term way to counter the contribution of these abnormalities to arterial thrombosis is low-dose aspirin or other antiplatelet agents.

    “For primary prevention, the only available long-term approach to counter their contribution to arterial thrombosis is low-dose aspirin or other antiplatelet agents.”

  • The paper relies on this without support.

    Fibrates and nicotinic acid are the most commonly used drugs for elevated triglycerides and reduced HDL-C.

    “‡Fibrates and nicotinic acid are the most commonly used drugs for elevated TG and reduced HDL-C.”

  • The paper relies on this without support.

    Metabolic syndrome is a multidimensional risk factor condition.

    “statement attempts to provide an integrated approach to the management of a multidimensional risk factor condition.”
9 of 9

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Hypertriglyceridemia is one of the components of the metabolic syndrome.

    “Hypertriglyceridemia is one of the components of the metabolic syndrome, a constellation of metabolic risk factors including a central distribution of adiposity or visceral obesity, insulin resistance, impaired glucose tolerance, hypertension, and high triglycerides and/or low HDL-C, associated with an atherogenic, procoagulant, and proinflammatory state (125).”

    From Evaluation and Treatment of Hypertriglyceridemia: An Endocrine Society Clinical Practice Guideline (2012) · cites this paper as [125]

  • Participants were classified as having metabolic syndrome or not based on the IDF criteria.

    “They were classified as having MetS or not based on the IDF criteria [18] (Fig. 2), with 49,107 identified as having MetS and 219,835 without.”

    From Machine learning with the body roundness index and associated indicators: a new approach to predicting metabolic syndrome (2025) · cites this paper as [18]

  • Chronic kidney disease precedes end-stage kidney disease and substantially raises CVD risk, at least partly through diet-related CVD risk factors.

    “CKD, which precedes end-stage kidney disease, substantially increases the risk of CVD, at least in part through diet-related CVD risk factors.93”

    From Diet and Lifestyle Recommendations Revision 2006: A Scientific Statement From the American Heart Association Nutrition Committee (2006) · cites this paper as [93]

  • Some included studies reported lower cut-offs for hypertension (e.g., SBP >130 mmHg and/or DBP >85 mmHg) or based hypertension prevalence on medical records, self-report, or national classification codes.

    “Nevertheless, some studies reported lower cut offs for hypertension (i.e.SBP > _130mmHg and/or DBP > _85 mmHg) 42 or hypertension prevalence was based on medical records, self-report, or national classification codes for disease.”

    From Periodontitis is associated with hypertension: a systematic review and meta-analysis (2020) · cites this paper as [42]

  • In 2005, the NCEP-ATP III criteria were modified to suggest lower waist circumference cutpoints for Asian Americans (≥90 cm in men and ≥80 cm in women).

    “In 2005, the NCEP-ATP III criteria were modified to suggest lower waist circumference cutpoints for Asian Americans ($90 cm [35 inches] in men and $80 cm [31 inches] in women) (2).”

    From The CardioMetabolic Health Alliance (2015) · cites this paper as [2]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Conflicting optional non-HDL-C goals for moderately high-risk patients

    Minor

    Table 3 gives an optional non-HDL-C goal of <130 mg/dL for moderately high-risk patients, but its footnote gives <100 mg/dL for that same therapeutic option.

  • Identical reference has two publication years

    Minor

    References 9 and 79 list the same authors, title, journal, volume, and pages, but give publication years of 2004 and 2005, respectively.

2 of 2

The citation lists haven’t been fetched yet

References 195 · Cited by 11,961

Research works printed but not linked: 12

  1. 10.1161/circ.87.1.8419002 · DOI
  2. 10.1161/circ.95.1.69 · DOI
  3. Kylin E. Studien uber das Hypertonie-Hyperglyka “mie-Hyperurika” miesyndrom. Zentralbl Innere Med. 1923; 44: 105–127.
  4. Vague J. La differenciation sexuelle, facteur determinant des formes de l;obesite. Presse Med. 1947; 30: 339–140.
  5. 10.1161/01.CIR.102.2.179 · DOI · Paper page
  6. 10.1161/circ.101.7.828 · DOI
  7. 10.1161/circ.102.18.2284 · DOI
  8. 10.1097/01.mol.0000137220.39031.3b · DOI
  9. 10.1161/circ.104.25.3046 · DOI
  10. 10.1161/circ.98.23.2513 · DOI
  11. American Diabetes Assocation. Standards of medical care in diabetes. Diabetes Care. 2005; 38: S4–S36.
  12. 10.1161/circ.103.15.1933 · DOI

Authors
Grundy, S. M., Cleeman, J. I., Daniels, S. R., Donato, K. A., Eckel, R. H., Franklin, B. A., Gordon, D. J., Krauss, R. M., Savage, P. J., Smith, S. C., Spertus, J. A., & Costa, F.
Affiliations
Wolters Kluwer Health (US)
ORCID
Venue
Circulation
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2005-10-25
Volume
112
Issue
17
Pages
2735-2752
ISSN
  • 0009-7322 (ISSN-L)
  • 1524-4539
DOI
10.1161/circulationaha.105.169404
OpenAlex
W2103714496
Semantic Scholar
a887b246f763e6fb67f2ed6c596a8595af955e27
Cited by
11,961
References
195
Citations by year
2026: 375 · 2025: 442 · 2024: 537 · 2023: 503 · 2022: 577 · 2021: 571 · 2020: 547 · 2019: 557 · 2018: 549 · 2017: 528 · 2016: 621 · 2015: 646 · 2014: 681 · 2013: 715 · 2012: 740
FWCI
50.14
Type
journal article
Language
en
Update notices
correction (2005-10-25)
Open access
Locations
  • Circulation (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diet, Metabolism, and Disease
Keywords
metabolic syndrome, diagnosis, management, cardiovascular risk
MeSH terms
Diabetes Mellitus, Type 2, Humans, Lipoproteins, National Institutes of Health (U.S.), Risk Factors, Societies, Medical, United States, Metabolic Syndrome

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-08.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-08.

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