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The aggregation of obesity, hyperglycaemia, hypertension, and dyslipidaemia (high TG’s and low HDL‐cholesterol) in people with both type 2 diabetes and cardiovascular disease is termed the metabolic syndrome (Table 7.1).

Figure 7.15 The ‘thrifty phenotype’ hypothesis.

Since several definitions appeared, there has been considerable debate as to their relative strengths and weaknesses. Indeed, there is some debate as to whether this constitutes a true syndrome at all and whether they add anything to predictive models for type 2 diabetes and coronary artery disease. A major problem is the correlation of many of the features. In prospective studies, fasting plasma glucose (FPG) is overwhelmingly linked to subsequent development of diabetes, but much less so with coronary artery disease. Thus, the predictive utility of the metabolic syndrome as a concept adds little to its constituent risk factors when they are used individually. The long‐term usefulness of the definition of the metabolic syndrome for identification and intervention in order to prevent diabetes and cardiovascular disease has yet to be demonstrated.