Fighting Against the “Hypertriglyceridaemic Waist”: A New International Institute for the Metabolic Syndrome

 

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About 17 million people throughout the world die every year from cardiovascular disease (CVD) according to the World Health Organization. This accounts for about 40 % of all deaths in industrialized countries like USA and UK, which is far more than cancer deaths which amount to about 25 %. There has been a downward trend of CV mortality over the last 2 decades resulting from consideration of major risk factors such as smoking, and treatment of hypertension, hypercholesterolaemia and diabetes, including the use of well-defined therapeutic strategies based on safe and effective drugs. However, CV mortality appears to finally have reached a plateau in the northern European countries and also the USA. Cardiovascular mortality, being higher in women than in men, contrary to the popular believe, is even increasing today in US-women. In eastern European countries CVD is progressing more substantially, and also in many developing countries, in parallel with industrialization, urbanization and changes in lifestyle. The percentage of people with a body-mass-index BMI ≥ 30 is growing not only in the USA but also in countries like e.g. Brazil.

The metabolic syndrome appears to be a major, if not the main underlying problem of CV mortality. It results from a genetic background, environment and lifestyle, and can be defined by 5 factors: a waist circumference of more than 102 cm in men and 88 cm in women, a blood pressure of ≥ 130/85 mm Hg, a fasting plasma glucose of ≥ 110 mg/dl, a high-density-lipoprotein (HDL)-cholesterol-fraction of < 40 and < 50 mg/dl in men and women, respectively, and a triglyceride level of ≥ 150 mg/dl. By measuring these 5 factors the “Deadly Quartet” - obesity, hypertension, dyslipideamia and hyperglyceamia - can easily be diagnosed. It has been observed in Germany with increasing frequency in the fifties and sixties of the last century after the 2nd world war and it has been named “Wohlstandssyndrom” by Mehnert, Munich, in 1968. A comprehensive description of the syndrome in Germany has been given by Hanefeld from Haller's Department in Dresden in 1973.

For screening, the phenotype of a “hypertriglyceridaemic waist” appears to be a simple and reliable parameter for detecting more than 80 % of all people with metabolic syndrome who, although many of them being asymptomatic, run a high risk of suffering from cardiovascular disease. This topic was addressed in the lecture of Professor Jean-Pierre Deprés, Quebec, Canada, in Paris on March, 27, 2003 at the launching symposium of the “International Metabolic Syndrome Institute”. This institute, being unique in the world as pointed out by its president, Professor Philip Barter, Sydney, should have three missions:

to increase knowledge about the metabolic syndrome, to circulate this knowledge to health professionals, government authorities and a general public, to stimulate and support research into metabolic syndrome.

An international scientific committee with 12 members including Professor Deprés, Canada, Professor Taskinen, Finland, Professor Zimmet, Australia and Professor Crepaldi, Italy, will direct the work performed by the institute on the fields of cholesterol and other blood fats, diabetes, heart diseases, obesity, genetics, epidemiology, health economics and fundamental research. This committee will be organized by an executive board that includes Philip Barter, chairman, Professor of Cardiology and director of the Heart Research Institute, Sydney, Australia, Frank Sacks, Professor of Cardiovascular Disease Prevention of Harvard, Boston, USA and Rury Holman, Professor of Diabetic Medicine, Oxford, UK.

The Metabolic Syndrome-Institute will be the financially supported by Laboratoires Fournier, France. This sponsorship will represent an unrestricted grant without directional impact on the institute's activities. Fournier-Pharma produces the lipid-lowering drug fenofibrate: The FIELD-Study (Fenofibrate Intervention & Event Lowering in Diabetes) that Fournier-Pharma has launched is a phase-III clinical study with fenofibrate testing a new indication of cardiovascular event prevention in type 2 diabetes patients. Professor Philip Barter, Sydney, acts as the principal investigator of this study. The trial started in 1998 and should be finished by 2005. It includes about 10,000 Australian patients treated for 5 years with either fenofibrate or placebo. Other lipid-lowering drugs like statins can be given according to the patient's necessities and the judgement of the treating physicians. This study should provide many informations on the disease and its treatment including special subgroups of patients. Furthermore, a combination preparation of fenofibrate and metformin is currently in phase II of development at the Laboratoires Fournier, with the indication for metabolic syndrome and type 2 diabetes.

In summary, a still better understanding of the metabolic syndrome and its sequelae, a higher awareness and an earlier diagnosis of this cardiovascular risk factor should emerge from the activities of the new international “Metabolic Syndrome Institute”, and also new effective pharmacotherapeutic options including the fibrates. Experimental and Clinical Endocrinology & Diabetes wishes good luck to the Executive Board and the members of the Scientific Committee of the Metabolic Syndrome Institute, and much success in all their activities!

Helmut Schatz, Bochum
Editor-in-Chief

Martin Wehling, Mannheim
Editor-in-Chief