Introduction

Background

At the beginning of the twentieth century, Kylin, a Swedish physician detected the aggregation of multiple cardiovascular risk factors when he came up with the description of a syndrome that involving hypertension, hyperglycemia and hiperuricemia [1]. In the 1940s, Dr. Jean Vague, a French clinician wrote out about abdominal obesity and fat distribution and its relation to diabetes and other disorders [2]. In 1965, an abstract was revealed at the European Association for the Study of Diabetes annual meeting by Avogaro and Crepaldi, which described a syndrome comprised hypertension, hyperglycaemia, and obesity [3]. In 1988, Gerry Reaven described a cluster of risk factors for diabetes and cardiovascular disease and demonstrated as ‘Syndrome X’. His main contribution was the introduction of the concept of insulin resistance [4,5]. His main contribution was the introduction of the concept of insulin resistance. In 1989, the syndrome was reintroduced by Kaplan as ‘The Deadly Quartet’ and in 1992 it was again renamed ‘The Insulin Resistance Syndrome’ [6]. At the present time, it was agreed that the well-established term ‘Metabolic syndrome’ remains the most usual description of this cluster of metabolic abnormalities [7]. There are several definitions for the metabolic syndrome. The National Cholesterol Education Program (NCEP/ATP III) and International Diabetes Federation (IDF) definitions are the most widely used. Current ATP III criteria define the metabolic syndrome as the presence of any three of the following five traits: Abdominal obesity, defined as a waist circumference in men >102 cm and in women >88 cm. Serum triglycerides ≥ 150 mg/dL (1.7 mmol/L). Serum HDL cholesterol <40 mg/dL (1 mmol/L) in men and <50 mg/dL (1.3 mmol/L) in women. Blood pressure ≥130/85. Fasting plasma glucose (FPG) ≥110 mg/dL (5.6 mmol/L) [8]. IDF proposed a set of metabolic syndrome criteria in 2004. Central obesity is an essential element in this definition, with different waist circumference thresholds set for different race/ ethnicity groups: Waist circumference in men ≥ 94 cm and in women ≥ 80 cm, this is for Europe’s people. For the Eastern Mediterranean and Middle East (Arab) populations, they recommend using European data until data that are more specific are available. MOREOVER, any two of the following: Triglycerides ≥ 150 mg/dL (1.7 mmol/L) or treatment for elevated triglycerides. HDL cholesterol <40 mg/dL (1.03 mmol/L) in men or <50 mg/dL (1.29 mmol/l) in women, or treatment for low HDL. Systolic blood pressure ≥ 130, diastolic blood pressure ≥85, or treatment for hypertension. Fasting plasma glucose ≥ 100 mg/ dL (5.6 mmol/L), or previously diagnosed type 2 diabetes. An oral glucose tolerance test is recommended for patients with elevated fasting plasma glucose, but not required. The prevalence of the metabolic syndrome in Member States of the Gulf Cooperative Council (GCC; Bahrain, Kuwait, Oman, Qatar, Saudi Arabia and the United Arab Emirates)-countries ranged from 20.7% to 45.9% [9]. People with Metabolic syndrome are twice as likely to die from and three times as likely to have a heart attack or stroke compared with people without the síndrome [10]. In addition, almost 200 million people globally have diabetes and 80 percent of these will die from cardiovascular disease, so there is an overwhelming moral, medical and economic imperative to identify those individuals with metabolic syndrome early, so that lifestyle interventions and treatment may prevent the development of diabetes and/or cardiovascular disease.

Clinical outcomes of metabolic syndrome ATP III viewed CVD as the primary clinical outcome of metabolic syndrome. Most individuals who develop CVD have multiple risk factors and most individuals with this syndrome have insulin resistance, which grants increased risk for type 2 diabetes. When diabetes becomes clinically obvious, CVD risk rises severely. Beyond CVD and type 2 diabetes, individuals with metabolic syndrome seemingly are susceptible to other conditions, notably polycystic ovary syndrome, fatty liver, cholesterol gallstones, asthma, sleep disturbances, and some for metabolic syndrome of cáncer [11].