The ADA and AHA Butt Heads Over Metabolic Syndrome

Two of the biggest health organizations in the United States, the American Diabetes Association (ADA) and the American Heart Association (AHA) are butting heads over whether or not metabolic syndrome exists.

This is surprising news.

You see, in recent years, the revered American Heart Association and many respected cardiologists worldwide have been repeatedly warning us that more and more folks -- some 25 percent of the U.S. population or a whopping 47 million people -- suffer from a cluster of risk factors that means we're prone to heart disease, stroke and diabetes.

Specifically, patients have been alerted that if they have three or more of the following symptoms -- abdominal obesity, high blood pressure, cholesterol abnormalities and a pre-diabetic condition called impaired glucose tolerance -- they have metabolic syndrome, which is also called insulin resistance syndrome or syndrome X.

Up until now, it seems, many members of the medical community across the board have taken the warnings to heart.

But now, both the American Diabetes Association and the European Association for the Study of Diabetes, in a paper published in the September issue of Diabetes Care and Diabetologia, are shooting holes in the American Heart Association-supported theory.

The ADA and the European diabetes group argue that metabolic syndrome is poorly defined and inconsistently used and that it needs further research.

The authors of the paper even say that doctors shouldn't be diagnosing people with this"syndrome." They argue that physicians shouldn't try to treat it until the science behind it is better understood. Rather, they suggest that M.D.s should treat each symptom as a separate condition.

I'm confused.

Look, I'm no doctor -- I'm just a freelance journalist/author and blogger -- but why the heck would the ADA and the European group now, of all times, come out against a theory that's been gaining increasing momentum for decades?

Why would they choose to blast a concept that already has the support of many cardiologists and the American Heart Association?

Why put down a recognized syndrome that National Heart Lung and Blood Institute is using as the focus of heart disease research and prevention?

And why the heck would these diabetes groups waste their time trying to debunk this theory? Why not put their resources to better use to fight diabetes?

In fact, as far back as 1988, Stanford University endocrinologist Gerald Reaven, M.D. coined the term "Syndrome X" (rather than metabolic syndrome) to describe this cluster of factors that increase the likelihood and severity of heart disease, stroke and diabetes.

What's more, the American Heart Association's website is full of information about metabolic syndrome.

There was even a widely reported Insulin Resistance Syndrome Task Force (jointly presented by the American College of Endocrinology and the American Association of Cliinical Endocrinologists).

The co-chair, Danieul Einhorn, M.D., F.A.C.E., said that "the prevalence of Insulin Resistance Syndrome has skyrocketed 61 percent in the last decade."

Ironically, even the American Diabetes Association -- which is now debunking the metabolic syndrome theory -- posts a lot of information about metabolic syndrome on its website!

But now, the ADA's chief scientific and medical officer, Richard Kahn, is saying, "We don't believe there's a syndrome. We don't believe that the whole is greater than the sum of the parts. We don't believe that the formula is grounded in scientific evidence."

Huh?

You need more scientific evidence?

Isn't it enough to have all these well-respected cardiologists and researchers gathering data, etc. on this since 1988?

Would someone please explain to me what's going on?

Is something else going on here behind the scenes rather than differences in medical opinions between major health organizations?

Might it have something to do with drug companies?

Interestingly, according to USA Today, by calling into question the existence of metabolic syndrome, the ADA and the European diabetes group are threatening the potential market for the experimental quit-smoking -and-weight-loss drug, rimonabant, to be sold as Acomplia. In fact, the drug's maker, Sanofi-Aventis, already bills rimonabant on its Web site as "a comprehensive management approach" to metabolic syndrome.

In their conclusion, the authors wrote that metabolic syndrome requires much more study before it warrants designation as a "syndrome" and before "its clinical utility is adequately defined." 

They suggest that, in the meantime, doctors continue to check patients to see if they discover other heart disease risk factors; to aggressively treat individual risk factors; to avoid labeling patients with "metabolic syndrome," and to not attempt prescribe a treatment for this "syndrome" until new, solid evidence is obtained.

If someone knows something, please explain to us what this is all about!

And why, oh why, unless I've been missing something, don't more of these news reports stress more about how important it is to lose weight, exercise, quit eating so many sweets and refined carbs to keep heart disease and diabetes at bay in the first place?

Thank goodness at least for cardiologist Scott Grundy of the University of Texas Southwestern Medical Center at Dallas, who USA Today describes as "one of the leading proponents of the concept at the heart association." He reportedly said to the newspaper that "most doctors recognize that the conditions that make up metabolic syndrome often occur together and should trigger lifestyle changes that reduce the patient's risk of heart disease."

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