Translate AMICOR contents if you like

Saturday, October 31, 2009

Global health risks

From: Ruggiero, Mrs. Ana Lucia (WDC) <>
crossposted from:

Global health risks

World Health Organization, October 2009

Available online as PDF file [70p.] at:

A response to the need for comprehensive, consistent and comparable information on health risks at global and regional level.

Global health risks is a comprehensive assessment of leading risks to global health. It provides detailed global and regional estimates of premature mortality, disability and loss of health attributable to 24 global risk factors.

“……A description of diseases and injuries and the risk factors that cause them is vital for health decision-making and planning. Data on the health of popu lations and the risks they face are often fragmen tary and sometimes inconsistent. A comprehensive framework is needed to pull together information and facilitate comparisons of the relative importance of health risks across different populations globally.

Most scientific and health resources go towards treatment. However, understanding the risks to health is key to preventing disease and injuries. A particular disease or injury is often caused by more than one risk factor, which means that multiple interventions are available to target each of these risks. For example, the infectious agent Mycobacte rium tuberculosis is the direct cause of tuberculosis; however, crowded housing and poor nutrition also increase the risk, which presents multiple paths for preventing the disease. In turn, most risk factors are associated with more than one disease, and targeting those factors can reduce multiple causes of disease. For example, reducing smoking will result in fewer deaths and less disease from lung cancer, heart dis ease, stroke, chronic respiratory disease and other conditions. By quantifying the impact of risk factors on diseases, evidence-based choices can be made about the most effective interventions to improve global health….”

This document – the Global health risks report – provides an update for the year 2004 of the compara tive risk assessment (CRA) for 24 global risk factors

Key figures and graphs [ppt 1.17Mb]

The Report in Sections


:: Front cover, table of contents and summary [pdf 930kb]
:: Part 1: Introduction [pdf 994kb]
:: Part 2: Results [pdf 1.57Mb]
:: Part 3: Joint effects of risk factors [pdf 443kb]
:: Annex A: Data and methods [pdf 841kb]
:: References [pdf 148kb]

Friday, October 30, 2009

INTERNET: October 30, 1969 (ProCOR)

ProCor colleagues,

The internet was born in 1969, on October 30. Originally created by the Pentagon for military use during the Cold War, four decades later it is becoming truly global--non-Latin characters will soon be used for web and email addresses.

"The internet's birth was in the depths of the Cold War, created for scientists to exchange some very hot data--the design and testing of nuclear weapons, for instance. Its transformation from its militaristic beginnings to where it stands now should be seen as the greatest 'swords into plowshares' story in the history of mankind. Because today, while its origins are at best dimly remembered, what it has morphed into has gone far, far beyond the original intent--and changed our planet and our way of life as a result." (Chris Weigant, "From the Pentagon To Monty Python: The Internet Turns 40" Huffington Post. Read full article:

In 1985, Dr. Bernard Lown received the Nobel Peace Prize for co-founding International Physicians for the Prevention of Nuclear War and used the prize money to purchase a low-earth-orbit satellite and create a new organization, SatelLife, which began transmitting health information to people in developing countries. His goal was to transform the technology of "star wars" to "star health," he said at the time. ProCor was founded in 1997 to promote cardiovascular disease prevention using low-cost communication technologies, which have emerged far beyond the internet to include a range of digital formats and wireless devices that augment or even replace the internet in many settings.

Internet addresses containing non-Latin characters will be online soon thanks to a decision announced on the internet's 40th birthday. More than one billion people worldwide are using the internet. China tops the list, representing nearly 20% of its audience. Japan is third, with 6%, India seventh. Russia and South Korea also are among the top 15 countries. "The coming introduction of non-Latin characters represents the biggest technical change to the Internet since it was created four decades ago," said Peter Dengate Thrush, President of the Internet Corporation for Assigned Names and Numbers (ICANN) at a board meeting in Seoul, South Korea. "Right now internet address endings are limited to Latin characters--A to Z. But the Fast Track Process is the first step in bringing the 100,000 characters of the languages of the world online for domain names. This is only the first step, but it is an incredibly big one and an historic move toward the internationalization of the internet." (Read more:

Some things never change, though. During transmission of its first message, "LOGIN," the internet crashed and "LO" was all that was delivered. With the advent of instant messaging and text messaging, a new electronic language has developed, and reading about the inaugural internet crash made me LOL ("laugh out loud").

While acknowledging that the internet has limitations and presents challenges, let's today celebrate the birthday of an innovation that has done much, and holds much more potential, to connect and contribute to our global community.

Catherine Coleman
Editor in Chief, ProCor
Dear Catherine,

Thanks for your message that I will post on our Blog. My first intention was to send you our greetings from Brazil, but immediately I realized that it is now nonsense; geography doesn't matter today; but I wish to say to you and ProCor: GREETINGS FROM THE AMICOR!

Even though shocking, perhaps, the creation of the INTERNET as a war effort may have some lesson to us -- perhaps as an answer to the question Professor Bernard Lown asked me in 2003, during a breakfast in New Orleans: "Why are so few of our colleagues enthusiastic about networking in ProCor?"

Probably we doctors are feeling ourselves excessively sure. We are healthy and socially well supported for a while. We are not conscious of the dangers hidden in our profession. Perhaps networking patients, and people socially in danger, it would be more rapidly convincing.

Time passed, with the efforts and persistence of you and other friends from ProCor we are seeing a progressive awareness.

Sincerely yours,

Aloyzio Achutti (and all AMICOR)

Wednesday, October 28, 2009

Alan Gregg

"The Human race has had long experience and fine tradition in surviving adversity; but now we face a task for which we have little experience, the task of surviving prosperity"
Alan Gregg (1890-1957)
Rockfeller Foundation

Tuesday, October 27, 2009

Reanimação Cardio-Respiratória

De: Maria Inês Reinert Azambuja

Folha Online

27/10/2009 - 08h46

Respiração boca a boca reduz chances de sobrevivência

da Folha de S.Paulo

Antes preconizada como parte importante da ressuscitação cardiopulmonar, a respiração boca a boca prejudica o procedimento e reduz as chances de sobrevivência do paciente com parada cardíaca.

Estudos apontam uma taxa de sobrevivência três vezes maior em pessoas submetidas apenas às compressões contínuas no peito até a chegada de socorro. Por esse motivo, a Ilcor (Aliança Internacional dos Comitês de Ressuscitação, na sigla em inglês), entidade que reúne as principais associações de cardiologia, mudará a partir de 2010 as diretrizes para procedimentos de emergência em parada cardíaca. De acordo com a nova orientação, somente a massagem cardíaca deverá ser aplicada pelo leigo.

"É simples entender por quê. Quando o coração para, o mais importante é manter o fluxo sanguíneo com a compressão. A respiração boca a boca é uma das causas que levam a diminuição do fluxo," afirma o cardiologista Sérgio Timerman, do InCor (Instituto do Coração).
O consenso será publicado nos principais periódicos internacionais de cardiologia em outubro de 2010, mas já vem sendo discutido em vários países, incluindo o Brasil.

O voluntário deve ficar ao lado do paciente e iniciar as compressões, pressionando a região entre os mamilos 4 cm para baixo e retornando à posição inicial até a ajuda chegar.

"O leigo deve esquecer a respiração boca a boca e aplicar somente compressão a partir de agora. Essa é uma das maiores descobertas da emergência cardiovascular dos últimos tempos. Para médicos, a orientação é que a massagem deve ser prioridade, antes de se preocuparem com choque, medicamentos etc.", afirma o cardiologista Manoel Canesin, coordenador do Centro de Treinamento em Emergências Cardiovasculares da Sociedade Brasileira de Cardiologia.

Haverá mudanças também com relação ao uso do desfibrilador. A aplicação de choque pode ocorrer antes da massagem somente até cerca de quatro minutos após a parada do coração. Depois desse tempo, a compressão deve preceder o uso de desfibrilador. Isso porque, após esse período, há alterações metabólicas no organismo e o coração precisa ser preparado com a compressão antes de receber o choque.

São Paulo, terça-feira, 27 de outubro de 2009

Why the swine flu virus is not a major threat

No, I don’t, but when you look at the WHO pandemic preparedness document, which is 62 pages long, you see in the citation count only 2 references for hand washing, 3 for masks, 1 for gloves, 23 for vaccines and 18 for anti-viral drugs. What WHO should be pushing worldwide, especially for poor countries, are these public health interventions; instead, it’s pushing pharmacologic interventions. We now have clear evidence from our reviews that pharmaceutical industry-sponsored influenza vaccine studies have risen in importance and visibility, considerably more than non-pharmaceutical industry-sponsored studies. However, this is not explained either by size or quality of the studies which is the same. The likely, and very unpalatable, explanation for this finding is that the most prestigious scientific journals are more likely to print pharmaceutical industry-sponsored studies probably because of the money they make out of selling reprints of the studies and advertising space./.../

Monday, October 26, 2009

Health Sciences Online

World Stroke Day 2009: 29 October

WORLD STROKE DAY 2009: "Stroke, what can I do?"

The theme for the World Stroke Day 2009 is "Stroke, what can I do?"

This question implies that everyone can do something about stroke. Individuals can learn their risk for stroke and do something about it, they can learn the symptoms of stroke and what to do about them, and they can help advance the stroke cause in many other roles: as a physician, a nurse, a healthcare professional, a patient, a caregiver, a donor, a business person, a citizen, a member of a voluntary organization, a policymaker, a member of government etc. The theme has been developed to prompt individuals, groups and governments to take action against stroke either at a personal, or group level.

This year we are encouraging people all over the world to run World Stroke Day events. The WSO will be delivering tools to support this activity including lists of ideas for activities and media releases. The WSO will also be providing an award to the best, most innovative, and most powerful activities in different regions to recognize efforts that heighten stroke awareness.

WSD 2009 Brochure | Printable version

World Stroke Day Brochure - Page 1 World Stroke Day Brochure - Page 2 World Stroke Day Brochure - Page 3 World Stroke Day Brochure - Page 4

WSD 2009 Poster | Printable version

World Stroke Day Poster - Page 1

Pericardial fat a better predictor of CHD than BMI

Pericardial fat a better predictor of CHD than BMI
OCTOBER 23, 2009 | Lisa Nainggolan

Winston-Salem, NC- A new study has shown that fat around the heart—so-called pericardial fat—predicts coronary heart disease (CHD) independent of conventional risk factors [1].

In fact, pericardial fat may be a better predictor of an individual's future risk of CHD than either body-mass index (BMI) or waist circumference, say Dr Jingzhong Ding (Wake Forest University School of Medicine, Winston-Salem, NC) and colleagues in their paper in the September 2009 issue of theAmerican Journal of Clinical Nutrition.

Ding told heartwire: "We and other groups have previously found in cross-sectional studies that pericardial fat is related to coronary artery disease. Our new study extends the findings to demonstrate that pericardial fat predicts the future development of clinical events of CHD and that this kind of prediction is beyond that conferred by conventional obesity measures—the first time this has been shown."/.../

Saturday, October 24, 2009

As Megacidades

As Megacidades do país, elas ainda têm solução

Outros vídeos

Bicicletas: Dicas de segurança para circular na cidade
A solução foi cobrar
Ideias mortas

Em Megacidades
Seção da Organização das Nações Unidas para as cidades. Dá acesso a publicações eletrônicas sobre temas urbanos (em inglês).
Mantido pela rede Metropolis, criada em 1985 para incentivar o intercâmbio de informações e experiências entre as grandes cidades.
Instituto virtual que reúne mais de 200 pesquisadores de 51 instituições universitárias de todo o país.
Movimento "Como Vamos", inspirado na experiência bem-sucedida iniciada em Bogotá, capital da Colômbia. No Brasil, 22 cidades integram a rede.
Organização não-governamental voltada para a capacitação de quadros e a idealização e desenvolvimento de soluções relacionadas a políticas públicas, urbanas e regionais.



Fofinhos, não...

Anna Paula Buchalla

Fotos Laílson Santos
Idade: 8 anos
Raça: vira-lata
Peso: 11,9 quilos
Peso ideal: 6 quilos
Males atribuídos à obesidade:artrose, problemas respiratórios e triglicérides e colesterol altos


A obesidade tornou-se o problema de saúde mais frequente - e preocupante - entre cães e gatos de estimação. Segundo o último levantamento da Associação Médica Veterinária Americana, 40% dos cães dos Estados Unidos carregam quilos extras. No Brasil, a estimativa é que 30% dos cães e 25% dos gatos sejam obesos.

Health Situation in the Americas: 2009

Health Situation in the Americas: Basic Indicators 2009PDFPrintE-mail

Chronic noncommunicable diseases currently are reaching epidemic proportions in the Americas and are contributing substantially to overall mortality and disease burden in the Region. They result from complex and dynamic socially determined health processes, including epidemiological and demographic transitions. Once thought to be an issue primarily affecting the older population in high-income countries, chronic noncommunicable diseases are now affecting younger population segments and the poor in the lower-income countries of Latin America and the Caribbean.

The means for preventing and controlling most noncommunicable diseases are already well established and high-income countries—followed by middle-income countries— are now showing continuous progress in both prevention and control interventions.

The low- and lower-middle-income countries, on the other hand, face the dual challenge of coping with scarce resources to address both noncommunicable and communicable diseases, as well as infant and maternal mortality.

Among chronic noncommunicable diseases, cardiovascular diseases are a leading cause of morbidity and mortality in the Americas, occurring increasingly within the working age population and thereby contributing disproportionately to the loss of potential years of healthy life and economic productivity. This situation is already recognized as a major and growing public health problem, particularly affecting low- and middle-income countries, but what is less recognized is the role of social disparities as determinants of the premature mortality due to cardiovascular diseases in the Region.

The purpose of this publication is to call the attention of the general public and the governments of the Americas to an exploratory analysis of the relationship between premature mortality due to cerebrovascular diseases (CeVD) and potential socioeconomic inequality determinants at the ecological level.

The map on the first page of this brochure depicts the quintile distribution of proportional premature mortality due to cerebrovascular disease in the countries and territories of the Americas.

The material presented in this brochure has been compiled, drafted, and reviewed by PAHO regional staff, and staff from ministries of health.

icon Basic Indicators 2009

Elinor Ostrom

Ostrom, the Arthur F. Bentley Professor of Political Science at Indiana University (Bloomington, IN) and cofounder and codirector of Indiana University's Workshop in Political Theory and Policy Analysis, has studied how self-organization and local-level management works to keep common resources, whether natural (e.g., forests) or man-made (e.g., police forces), viable. Combining data from diverse sources ranging from classical techniques such as surveys to modern advances such as satellite imagery, Ostrom has uncovered numerous principles that govern successful sustainability and that defy conventional beliefsBorn in Los Angeles in 1933, Elinor Ostrom experienced firsthand the value of sustainability at a young age. She grew up in an era of economic depression that led into a resource-consuming war, in a city where fresh water was a prized commodity. “My mother had a victory garden during the war,” she recalls, “so I learned all about growing vegetables and preserving them by canning, and that was a wonderful experience that a lot of urban kids don't ever learn.” These early real-world lessons also revealed another important fact of life to Ostrom: that most people, when presented with a resource problem, can cooperate and act for the common good.

Omnivore's Dilemma

Sir Richard Doll

Smoking Kills: The Revolutionary Life of Richard Doll
“Death in old age is inevitable but
death before old age is not.”—Richard Doll

At the end of the Second World War, Britain had the highest incidence of lung cancer in the world. For the first time lung cancer deaths exceeded those from tuberculosis - and no one knew why.

On 30 September 1950, a young physician named Richard Doll concluded in a research paper that smoking cigarettes was “a cause and an important cause” of the rapidly increasing epidemic of lung cancer. His historic and contentious finding marked the beginning of a life-long crusade against premature death and the forces of “Big Tobacco”.

Born in 1912, Doll, a natural patrician, jettisoned his Establishment background and joined the Communist Party as a reaction to the “anarchy and waste” of capitalism in the 1930s. He treated the blistered feet of the Jarrow Marchers, served as a medical officer at the retreat to Dunkirk, and became a true hero of the NHS. A political revolutionary and an epidemiologist with a Darwinian heart-of-stone, Doll fulfilled his early ambition to be “a valuable member of society”.

Doll steered a course through a minefield of medical and political controversy. Opponents from the tobacco industry questioned his science, while later critics from the environmental lobby attacked his alleged connections to the chemical industry. An enigmatic individual, Doll was feared and respected throughout a long and wide-ranging scientific career which ended only with his death in 2005.

In this authorised and groundbreaking biography, Conrad Keating reveals a man whose life and work encapsulates much of the twentieth century. Described by the British Medical Journalas “perhaps Britain’s most eminent doctor”, Doll ushered in a new era in medicine: the intellectual ascendancy of medical statistics. According to the Nobel laureate Sir Paul Nurse, his work, which may have prevented tens of millions of deaths, “transcends the boundaries of professional medicine into the global community of mankind.”

Conrad Keating is the Writer-in-Residence at the Welcome Unit for the History of Medicine at Oxford University. As a professional historian he has written for newspapers, radio and television. Born in Ireland he has lived much of his life in the UK.

ISBN 1-904955-63-0
£17.99 (hardback)
November 2009, 352pp, maps, 20 b&w illus, 215x140

Friday, October 23, 2009

Environmental Cost of Biofuels


Tallying the Real Environmental Cost of Biofuels

William Radcliffe / Science Faction / Corbis

The promise of biofuels like ethanol is that they will someday help the world grow its way out of its addiction to oil. Nine billion gallons of corn ethanol were produced in the U.S. in 2008, while countries like Brazil have already widely replaced gasoline with ethanol from sugar cane and countless start-ups are working to bring cellulosic and other second-generation biofuels to market. The reasoning is that if we use greener biofuels in place of gasoline, it will significantly enhance our effort to reduce greenhouse-gas emissions.

Thursday, October 22, 2009

equations may overestimate CVD risk

Current risk equations may overestimate CVD risk in diabetic patients
OCTOBER 21, 2009 | Marlene Busko

Montreal, QC - The Framingham and United Kingdom Prospective Diabetes Study (UKPDS) risk equations overestimate the probability of CV events in people with type 2 diabetes, according to several reports in an oral presentation session here at the International Diabetes Federation(IDF) 2009 World Diabetes Congress [1].

"The key observation that seems to be emerging is that current risk models overestimate CV event risk in diabetes patients," session cochair Dr Naveed Sattar (University of Glasgow, Scotland) toldheartwire, adding that the reasons for this overestimation are unclear.

"On the one hand, most countries are now treating patients with diabetes as if they are all CHD-risk equivalent, and clearly, the overestimation of risk scores suggests that that is potentially wrong," he said./.../

Global Health - Policy Glossary - start
The Updated European Global Health Policy Glossary

Nearly 100 entries, each a short article introducing main concepts.

The glossary is a living resource; each article should be seen as a starting point for discussion.

If your views are not represented we invite you to log in and comment.

Discussion series 1: The EU´s role in Global Health
The European Commission has launched its issue paper on the EU's Role in Global Health for a two month open consultation.

The issue paper sets out a series of key challenges and concepts to be addressed during a programme of consultation within EU agencies, with member states and aid recipient countries, and with academic, business and civil society groups. The aim is to gain stakeholder feedback on potential EU added value in the field of global health.

The issue asks stakeholders to develop a common understanding of "global health," "European values for global health" and in particular our approach to "inequity and inequality" in health, the impacts of "globalisation on health" the need for "global health research", issue of "health migration" and the need to improve "global health governance". It also introduces issues such as "global public goods for health" and "health security".

Our glossary provides definitions and expansion of these topics which may help to further elucidate discussion of the issue paper.

You are invited to consider the definitions and explanations provided in the glossary in the light of the open consultation and to add to, comment on and improve these entries.

Desafio Montanha do Saber

Desafio Montanha do Saber

A Parceiros Voluntários convida você e seus amigos para ajudar na arrecadação de livros e assim montarmos a maior Montanha do Saber do nosso Estado! Todas as unidades arrecadadas serão doadas para diversas Bibliotecas Comunitárias que atendem a crianças e jovens, que não têm condições de adquirir bons livros. Nossa meta é arrecadar junto com você, 5.000 livros!

No dia 07 de novembro, sábado, das 10h às 17h,voluntários estarão recebendo as doações no Armazém A1 do Cais do Porto, no largo da Escrita, durante a 55ª Feira do Livro.

Acompanhe todas as novidades sobre a arrecadação no dia 07 de novembro através do Twitter e Facebook.

Participe! Leve a sua turma, convide os amigos e doe Livros!

Wednesday, October 21, 2009

What Is a City? What Is Urbanization?

by Carl Haub

(October 2009) In 2008, the United Nations announced that 50 percent of the world's population now lives in urban areas, a milestone in demographic history. News reports on the subject frequently rephrased this development slightly to say that half of the global population now lives in "cities" and illustrated articles with photos of Mumbai, Shanghai, or New York. These cities are what the UN terms "mega-cities," urban areas of 10 million people or more. The distinct impression was created that a majority of people lived in very large cities. However, only about 5 percent of world population lives in the largest cities or, more properly, metropolitan areas. The fact that over half of the world's population live in places termed urban is a notable development, to be sure. But, at the same time, it is useful and important to know just how the term "urban" is defined./.../

Deciphering Population Pyramids

(October 2009) "Distilled Demographics," PRB's video series, highlights key demographic concepts such as fertility, mortality, and migration. Through these short videos, you can learn demography's real-world application and impact.

Preventable causes of Death in the US

Research Article
The Preventable Causes of Death in the United States: Comparative Risk Assessment of Dietary, Lifestyle, and Metabolic Risk Factors

Goodarz Danaei1,2, Eric L. Ding1, Dariush Mozaffarian1,3, Ben Taylor4,5, Jürgen Rehm4,5,6, Christopher J. L. Murray7, Majid Ezzati1,2*
1 Harvard School of Public Health, Boston, Massachusetts, United States of America, 2 Initiative for Global Health, Harvard University, Cambridge, Massachusetts, United States of America, 3 Harvard Medical School, Boston, Massachusetts, United States of America, 4 Centre for Addiction and Mental Health, University of Toronto, Toronto, Canada, 5 Public Health Sciences, University of Toronto, Toronto, Canada, 6 Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany, 7 Institute for Health Metrics and Evaluation, The University of Washington, Seattle, Washington, United States of America

Knowledge of the number of deaths caused by risk factors is needed for health policy and priority setting. Our aim was to estimate the mortality effects of the following 12 modifiable dietary, lifestyle, and metabolic risk factors in the United States (US) using consistent and comparable methods: high blood glucose, low-density lipoprotein (LDL) cholesterol, and blood pressure; overweight–obesity; high dietary trans fatty acids and salt; low dietary polyunsaturated fatty acids, omega-3 fatty acids (seafood), and fruits and vegetables; physical inactivity; alcohol use; and tobacco smoking./.../

Tuesday, October 20, 2009

Communication on Solidarity in Health:


Brussels, 20 October 2009

The European Commission has released today a ’Communication on Solidarity in Health: Reducing health inequalities in the EU.’ The European Public Health Alliance welcomes the adoption of the long-awaited document and congratulates the Commission, and particularly Commissioners Vassiliou and Spidla, on delivering the first step in tackling health inequalities within and between Member States in Europe. A series of actions to help Member States and other actors tackle the gaps in health were announced./.../

Monday, October 19, 2009

Boletim de Saúde: 40 anos

Hoje, celebrando os 40 anos do Boletim de Saúde de
nossa Secretaria de Saúde do Estado RS, foi
lançada uma edição especial, coordenada pela
AMICOR Dr. Maria Inês Reinert Azambuja, sbre
a Gripe. Ela foi muito elogiada, pelo editor Dr. Paulo
Oliveira, Pela Diretora da Escola de SP Profa. Sandra
Vial e pelo Secretário da Saúde Dr. Osmar Terra.
Entre outros há um artigo nosso Maria InEs R.
Azambuja, Sérgio Luiz Bassanesi e A. Achutti: A
mortalidade por Doenças Respiratórias em Porto
Alegre é maior em áreas da cidade com piores
indicadores sociais"."

Metabolic Syndrome

(Circulation. 2009;120:1640-1645.)
© 2009 American Heart Association, Inc.

Joint Scientific Statement

Harmonizing the Metabolic Syndrome

A Joint Interim Statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity

K.G.M.M. Alberti, FRCP; Robert H. Eckel, MD, FAHA; Scott M. Grundy, MD, PhD, FAHA; Paul Z. Zimmet, MD, PhD, FRACP; James I. Cleeman, MD;Karen A. Donato, SM; Jean-Charles Fruchart, PharmD, PhD; W. Philip T. James, MD; Catherine M. Loria, PhD, MS, MA, FAHA;Sidney C. Smith, Jr, MD, FAHA

A cluster of risk factors for cardiovascular disease and type 2 diabetes mellitus, which occur together more often than by chance alone, have become known as the metabolic syndrome. The risk factors include raised blood pressure, dyslipidemia (raised triglycerides and lowered high-density lipoprotein cholesterol), raised fasting glucose, and central obesity. Various diagnostic criteria have been proposed by different organizations over the past decade. Most recently, these have come from the International Diabetes Federation and the American Heart Association/National Heart, Lung, and Blood Institute. The main difference concerns the measure for central obesity, with this being an obligatory component in the International Diabetes Federation definition, lower than in the American Heart Association/National Heart, Lung, and Blood Institute criteria, and ethnic specific. The present article represents the outcome of a meeting between several major organizations in an attempt to unify criteria. It was agreed that there should not be an obligatory component, but that waist measurement would continue to be a useful preliminaryscreening tool. Three abnormal findings out of 5 would qualify a person for the metabolic syndrome. A single set of cut points would be used for all components except waist circumference, for which further work is required. In the interim, national or regional cut points for waist circumference can be used.