Controversy in diagnosis and management of the metabolic syndrome.

Far more work remains to be done to unravel the tangled web of pathophysiology responsible for the metabolic syndrome. This article addresses several aspects of the current controversy surrounding the metabolic syndrome: (1) definition of the metabolic syndrome; (2) evidence for and against the use of the metabolic syndrome as a cardiovascular disease risk predictor; (3) evidence as to underlying pathophysiology; and (4) evidence for treatment of the metabolic syndrome (as opposed to components of the syndrome) in a risk reduction strategy to prevent type 2 diabetes mellitus or cardiovascular disease.