Of the 246 participants, 75 had metabolic abnormalities, 35 had diabetes mellitus, and of the diabetics, 18 also met the criteria for having metabolic syndrome.

Dr. Akosah added that 89% of the subjects had Framingham risk scores below 10%, indicating low risk for coronary heart disease.

All subjects underwent carotid ultrasound, and carotid atherosclerosis was detected in 149 of them. Dr. Akosash said that in the group with diabetes and metabolic syndrome, 88% had atherosclerosis, and in those with metabolic syndrome alone, 75% had atherosclerosis. In addition, among patients without metabolic syndrome or diabetes, the incidence of atherosclerosis was significantly lower, but it was still found in about half of those subjects.

"In spite of Framingham risk category, subjects had 2.5 times the risk of atherosclerosis if the metabolic syndrome was present" compared with those not meeting the criteria for the syndrome, Dr. Akosah told meeting attendees.

He pointed out that only 112 of the subjects in this primary care setting had a fasting blood sugar levels drawn, "indicating that we are not checking for metabolic syndrome, regardless of risk category.... We cardiologists are good at preaching what to do, but we don't always follow up."

"One of the first things we need to do is look at the patient," panel moderator Jorge Plutsky, MD, assistant professor of medicine at Harvard Medical School in Boston, Massachusetts, commented. "What does he look like?" Basic assessment should include waist circumference, blood pressure, blood glucose, triglyceride levels, and high-density lipoprotein cholesterol levels. "These are simple tools for assessment," he noted.

Initial treatment in this younger age group is very simple, with adoption of a healthy lifestyle, Dr. Akosah said. "The question has been, should we treat metabolic syndrome?... We should address this aggressively." He added that with such an aggressive workup, the clinician will find a subgroup who may benefit from pharmacologic therapy.

Source: Diabetes In Control.com: AHA 2004 Scientific Sessions: Abstract 2063. Presented Nov. 8, 2004.