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Vol. 64. Issue 10.
Pages 947-948 (October 2011)
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Vol. 64. Issue 10.
Pages 947-948 (October 2011)
DOI: 10.1016/j.rec.2011.06.004
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Does the Metabolic Syndrome Need More Descriptive Studies or More Evidence of Its Implication in Secondary Prevention? Response
¿El síndrome metabólico en España necesita más estudios descriptivos o más evidencia de su implicación en prevención secundaria? Respuesta
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Manuel F. Landechoa,
Corresponding author
mflandecho@unav.es

Corresponding author: mflandecho@unav.es
, Ana Fortuñob, Guillermo Zalbab, Oscar Beloquia
a Departamento de Medicina Interna, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
b Área de Ciencias Cardiovasculares, Centro de Investigación Médica Aplicada (CIMA), Universidad de Navarra, Pamplona, Navarra, Spain
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Rev Esp Cardiol. 2011;64:946-710.1016/j.rec.2011.05.030
Alberto Cordero, José Moreno-Arribas, Vicente Bertomeu-González, Vicente Bertomeu-Martínez
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To the Editor,

As Cordero et al. state in the current issue of Revista Española de Cardiología, our research group describes the association between the cluster of vascular risk factors known as the metabolic syndrome (MS)1 and the presence of subclinical and early vascular lesions that, once established, hardly ever return to normal.

The importance of this relationship lies in the fact that we know that MS doubles the risk of cardiovascular (CV) disease and triples the risk of CV death2; that it significantly increases the risk of advanced kidney disease3; and that patients with advanced kidney disease have an increased risk of death that can be almost 6-fold greater than that of patients with normal clearing.4 In fact, when signs of kidney disease appear, the structural lesion is already established and, as prevention is considered the best strategy in managing these patients, it is crucial to detect the earliest abnormalities so as to design specific interventions.5 Our findings confirm that MS is significantly associated with incipient deterioration of kidney function and increased intima-media thickness, but we cannot conclude these markers should be included in MS diagnostic criteria.

We coincide with other authors6 in our belief that management of these patients requires that we perform studies aimed at clarifying this marker's possible role in prognosis and in determining the most effective treatment.

We are fully aware of NHANES registry data for 20043 and cite the aforementioned study.1 Its authors evaluate advanced stages of kidney disease and the presence of microalbuminuria independently of the glomerular filtration rate. Therefore, in our opinion, our results complement and confirm these findings. We did not consider the 2005 MESYAS registry7 because it took account of the glomerular filtration rate in isolation, whereas our study looked at this in combination with the presence of microalbuminuria, in accordance with current American Society of Nephrology recommendations.8

Finally, we wish to make it clear that given diabetes and high blood pressure are well-known factors contributing to kidney damage, we excluded patients presenting these in order to study the real value of MS in evaluating subclinical CV disease.

Corresponding author: mflandecho@unav.es

Bibliography
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Relación entre las fases precoces de la enfermedad renal y el síndrome metabólico..
Rev Esp Cardiol. , 64 (2011), pp. 373-378
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Agrawal V, Shah A, Rice C, Franklin BA, McCullough PA..
Impact of treating the metabolic syndrome on chronic kidney disease..
Nat Rev Nephrol. , 5 (2009), pp. 520-528
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Chen J, Muntner P, Hamm LL, Jones DW, Batuman V, Fonseca V, et al..
The metabolic syndrome and chronic kidney disease in U.S. adults..
Ann Intern Med. , 140 (2004), pp. 167-174
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Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY..
Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization..
N Engl J Med. , 351 (2004), pp. 1296-1305
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Ritz E..
Kidney damage in metabolic syndrome: nip it in the bud..
Am J Kidney Dis. , 53 (2009), pp. 726-729
[6]
Lerman LO, Lerman A..
El síndrome metabólico y la enfermedad renal temprana: ¿un eslabón más de la cadena?..
Rev Esp Cardiol. , 64 (2011), pp. 358-360
[7]
Cordero A, Laclaustra M, León M, Casasnovas JA, Grima A, Nájar M, et al..
Factores de riesgo cardiovascular y síndrome metabólico asociados con la disfunción renal subclínica: subanálisis del Registro MESYAS..
Med Clin (Barc). , 125 (2005), pp. 653-658
[8]
Levey AS, Coresh J, Balk E, Kausz AT, Levin A, Steffes MW, et al..
National Kidney Foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification..
Ann Intern Med. , 139 (2003), pp. 137-147
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Revista Española de Cardiología (English Edition)

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