Emerging Issues

Metabolic syndrome represents a cluster of cardiovascular risk factors associated with overweight and obesity, especially abdominal obesity and insulin resistance. As obesity has increased, the prevalence of metabolic syndrome has risen, and currently about one-fourth of U.S. adults are estimated to have this syndrome.^{46, 47} The syndrome is diagnosed by the presence of three or more of the following five risk factors, as defined in the ATP III guidelines and refined in the joint American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement on Diagnosis and Management of the Metabolic Syndrome: abdominal obesity (waist circumference equal to or more than 40 inches in men and equal to or more than 35 inches in women), a high triglyceride level equal to or more than 150 mg/dL, high-density lipoprotein (HDL) cholesterol less than 40 mg/dL in men and less than 50 mg/dL in women, BP equal to or more than 130/85 (either systolic or diastolic elevation), and a fasting blood glucose level equal to or more than 100 mg/dL. First-line therapy for metabolic syndrome is lifestyle therapy, including weight management and physical activity, which improves the cardiovascular risk factors. Attention to metabolic syndrome can help to increase professional and public awareness of the need for lifestyle changes to reduce CVD risk.⁴⁸

An emerging trend of concern is the appearance among children of chronic diseases formerly characterized as adult onset. With the continued increase in overweight and obesity now affecting the pediatric population in larger proportions, chronic diseases like type 2 diabetes, high BP, and coronary artery disease have followed suit. Fortunately, programs are under way to combat this issue. Ways to Enhance Children's Activity and Nutrition (We Can!)⁴⁹ is a national public education program designed to address the dramatic increase in overweight and obesity in children. It is a collaboration among the U.S. Department of Health and Human Services' National Heart, Lung, and Blood Institute; National Institute of Diabetes and Digestive and Kidney Diseases; National Institute of Child Health and Human Development; and National Cancer Institute. We Can! provides a resource for parents and caregivers interested in practical tools to help children aged 8 to 13 years achieve and maintain a healthy weight. To date, more than 120 communities across the Nation have committed to the We Can! program.

Given the strong association of high BP with obesity and the increase in childhood obesity, both prehypertension and high BP are emerging health issues among young persons.^{50, 51} The National High Blood Pressure Education Program recently released The Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents.⁵¹ The report updates clinical recommendations for pediatric high BP, provides new BP tables for children, evaluates the evidence of early damage to organs primarily affected by high BP, and recommends the use of antihypertensive agents based on recent studies.^{52, 53} In addition, the report also describes how to identify hypertensive children, who need additional evaluation for sleep disorders that may be associated with BP elevation.

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