Karl Jung had a word for this Sychronicity.

Enjoy

Bill

.............

http://www.medpagetoday.com/Endocrinology/Diabetes/dh/3631

AHA and ADA Declare Truce in Metabolic Syndrome Squabble

 
By Peggy Peck, Managing Editor, MedPage Today
Reviewed by Rubeen K. Israni, M.D., Fellow, Renal-Electrolyte and
Hypertension Division, University of Pennsylvania School of Medicine
June 26, 2006
Also covered by: Yahoo! News

MedPage Today Action Points

  €  Explain to patients who ask that the disputed metabolic syndrome
is a compilation of a number of risk factors, including dyslipidemia,
hypertension, obesity, and insulin resistance.

  €  Be aware that both the AHA and ADA recommend using risk assessment
algorithms.
Review
DALLAS, June 26 ‹ The American Diabetes Association (ADA) and the
American Heart Association (AHA) have decided to paper over their public
differences on the validity of the metabolic syndrome as a treatable
diagnosis.
To that end, both groups today issued a joint statement declaring that
they remain "unified and committed to reducing the burden of diabetes
and cardiovascular disease."
The statement, which was being simultaneously published by Diabetes Care
and Circulation, Journal of the American Heart Association, said the
widespread publicity over the divergent views of the usefulness of
metabolic syndrome as a diagnosis was becoming counterproductive to the
overriding goals of both groups.
"Unfortunately, some of the medical press have positioned the scientific
issues related to the metabolic syndrome as a 'battle' between the
American Diabetes Association and the American Heart Association,
implicitly suggesting that cardiovascular disease risk factor
identification and treatment is now questionable," they wrote. "We are
concerned that the presumed dispute will lead to a reduction in the
favorable trend of many aspects of cardiovascular disease risk factor
reduction."
The joint statement was co-authored by AHA president Robert Eckel, M.D.,
ADA president Robert A. Rizza, M.D., along with Rose Marie Robertson,
M.D., and Richard Kahn, Ph.D., chief science officers of the AHA and the
ADA, respectively.
The joint statement emphasized agreement. It backed an emphasis on
treating "a core set of risk factors (pre-diabetes, hypertension,
dyslipidemia, and obesity)" as well as smoking. The statement
sidestepped the genesis of the still-simmering disagreement‹a dispute
that neither group tried to hide‹the definition of metabolic syndrome.
Last year the ADA signed onto a European Association for the Study of
Diabetes (EASD) statement published in the August issue of Diabetes
Care. It said, "We found that the metabolic syndrome has been
imprecisely defined, there is a lack of certainty regarding its
pathogenesis, and there is considerable doubt regarding its value as a
cardiovascular disease risk marker. Our analysis indicates that too much
critically important information is missing to warrant its designation
as a 'syndrome.' Until much needed research is completed, clinicians
should evaluate and treat all cardiovascular disease risk factors
without regard to whether a patient meets the criteria for diagnosis of
the 'metabolic syndrome.'"
A month later the AHA, along with the National Heart, Lung, and Blood
Institute, issued an updated statement on metabolic syndrome, which it
declared a real and growing health problem. The AHA/NHLBI statement
included one major change-it identified fasting glucose as a key risk
factor and dropped the threshold for elevated fasting glucose from 110
mg/dL to 100 mg/dL or higher, which matched the glucose threshold
endorsed by the ADA.
In a series of back and forth comments made at the European Society of
Cardiology meeting and the EASD in last September, the two organizations
traded soft jabs. Dr. Eckel, who is himself an endocrinologist at the
University of Colorado, said the diabetologists raised some valid points
about the metabolic syndrome definition. But he added there are "no
doubts that the metabolic syndrome exists."
At the same time Dr. Rizza of the Mayo Clinic in Rochester, Minn., said
he was not at all disturbed by the difference of opinion. "The real
issue is whether the concept of metabolic syndrome adds value to
treatment of persons with diabetes." He suggested it did not.
Dr. Kahn said from the ADA standpoint, "there doesn't appear to be any
evidence that a metabolic syndrome diagnosis is helpful. To step back
and say this (metabolic syndrome) doesn't exist is a train that is hard
to stop and reverse, but more and more people are challenging the
conceptŠI think the tide is actually turning on this concept."
Now, however, the AHA and ADA say they are putting their disagreements
aside in pursuit of the greater goal‹"a reduction in heart disease,
stroke and new-onset diabetes."
To that end they suggested that a useful tool for estimating risk of
diabetes and cardiovascular disease is
http://www.diabetes.org/diabetesphd/default.jsp, a free assessment tool
that has been "extensively validated" in a number of studies yet is
"rarely used in clinical practice."
A low tech approach, which they say may also be an effective first step,
is "simply ascertaining a person's blood glucose level, blood pressure,
LDL cholesterol level, and tobacco use and noting the presence of
obesity."
In a vague reference to metabolic syndrome, the statement cautioned that
even "borderline abnormalities, especially if they are multiple, may
well presage future problems and should be addressed."
The AHA/NHLBI defined metabolic syndrome as a group of metabolic risk
factors in one person. Those risk factors include abdominal obesity,
atherogenic dyslipidemia, elevated blood pressure, insulin resistance,
prothrombotic state and proinflammatory state.

Finally, the AHA/ADA statement concluded that despite "many unresolved
scientific issues, a number of cardiometabolic risk factors have been
clearly shown to be closely related to diabetes and cardiovascular
disease: fasting/postprandial hyperglycemia, overweight/obesity,
elevated systolic and diastolic blood pressure, and dyslipidemia.
Although pharmacologic therapy is often indicated when overt disease is
detected, in the early stages of these conditions, lifestyle
modification with attention to weight loss and physical activity may
well be sufficient."
Source reference:
Eckel RH et al "Preventing Cardiovascular Disease and Diabetes: A Call
to Action from the American Diabetes Association and American Heart
Association" Circulation 206; 113: 2943-2946