Síndrome ou pseudossíndrome metabólica?

Abstract

Metabolic syndrome has been proposed as a predictor of cardiovascular risk. However, such idea lacks strong scientific basis. This article reviews the evidence regarding that issue, challenging the existing paradigm of the prognostic value of metabolic syndrome.According to Hans Christian Andersen's tale (1837), once upon a time there lived a vain Emperor who ordered from two tailors an extraordinary suit, of such unique quality that nobody had ever seen a similar one. As the tailors could not fulfill the Emperor's wish, they conceived a wonderful suit, which would be invisible to anyone who was too stupid to appreciate its quality. The Emperor himself, while trying on his new clothes, could not see them on the mirror, but pretended to see them so as not to appear stupid. Similarly, everybody could see that the Emperor was naked, but nobody admitted it, since nobody was willing to admit his own stupidity. Thus, the Emperor spent a long time naked, exposed to ridicule. This tale explains why some medical myths last for so long, despite the lack of scientific basis. The metabolic syndrome, as an entity of great clinical value, seems to be a myth to be challenged. In reality, that entity holds a huge dissociation between its popularity and its real usefulness in medical decision making. The metabolic syndrome can be defined as the clustering of at least three of the following five criteria: increased abdominal circumference; high triglyceride levels; low HDL-cholesterol levels; high blood pressure; and glycemia ≥ 100 mg/dl 1 . That concept has gained importance with the seminal study by Reaven 2 , proposing a pathophysiological model in which insulin resistance/hyperinsulinemia would be the link responsible for the clustering of the cardiovascular risk factors commonly observed in clinical practice.However, extrapolating that pathophysiological hypothesis to the creation of a concept of metabolic syndrome used to predict cardiovascular events and the development of diabetes has not been well founded, exemplifying how myths can be created. Therefore, this brief review aimed at assessing, based on scientific evidence, whether metabolic syndrome really deserves credit for that.A predictive model is created based on the following: (1) identification of variables associated with an outcome in cohort studies, which are submitted to (2) multivariate analysis that defines which are the independent predictors of outcome and the relative value of each one. Drawing on such data, (3) those predictors are attributed points proportionally to their force of association with the outcome, generating a risk score. That was how the classical Framingham Score was created 3 . Differently, the metabolic syndrome has not been created based on the independent association between outcome and each of those components. In a simpler strategy, experts have clustered clinical and laboratory findings based on the assumption of a single pathophysiological construct, in which insulin resistance would provide the explicative link for the di...

Síndrome metabólica: análise conceitual no contexto da enfermagem

“…Concerning behavioral factors, we identified more studies with high level of scientific evidence, especially publications in the nursing field and/or developed by nurses. Authors of national 14 and international 5 studies point that nurses need to consider such factors when planning and prescribing nursing interventions directed to this clinical profile and population, in such a way to achieve results relevant to the nursing practice.…”

“…This health condition has been widely studied by researchers, with varying criteria and existing definitions for diagnosis, particularities, and prevalence in population and age groups, aiming to discuss the accuracy of its assumptions 4-5 and possible parameters that may be related such as neck circumference 6 and presence of Acanthosis nigricans 7 .…”