Of the next wave of chronic diseases that are expected to reach epidemic proportions in developed nations, the metabolic syndrome (MetS) must be viewed as among the most important. The rise of MetS to its current preeminence as a clinical problem is even more remarkable considering that this disease entity was essentially unknown - or at least invisible - before 1980. The heightened awareness of the importance of MetS as a worldwide major health concern is based on: (1) the shear breadth of its prevalence in westernized and westernizing countries; (2) its potential impact upon public health; and (3) its clinical importance as a target of new therapies. One index of the attention given to MetS is the citation of ~ 1000 articles in PubMed in the first 6 months of 2005 using the search term 'metabolic syndrome'; moreover, this pace of scientific citation and clinical awareness has been constantly accelerating since its initial description.

Although the clustering of the component metabolic disturbances that are characteristic of diabetes and hypertension had been well recognized for more than 40 years, the concept of MetS was first popularized in the mid-1980s by several scientists, especially by Reaven, who initially termed it 'syndrome X.'1 The significance of defining MetS as a clinical entity relates to its importance as a risk factor that can predict the subsequent development of diabetes and cardiovascular disease. The growing prevalence of MetS over the next several decades will feed the looming epidemic of diabetes and the resulting resurgence of atherosclerotic disease, which has been declining in relative terms over the past two decades.

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