As you are well aware, the obesity epidemic in the United States is prompting national attention in the media, specifically addressing diabetes onset and the metabolic syndrome. It is difficult to pick up a magazine or watch the news without finding some report on the issue. Even National Geographic recently had an article on "The Heavy Cost of Fat."1 It is terrific that the public eye is focusing on some of the issues that the American Heart Association and American Diabetes Associations have been trying to address and provides a natural vehicle for communication with your patients.

Here are some interesting, if not sobering, new statistics for you to consider:

* It is estimated that 47 million US residents have the metabolic syndrome.2

* The age-adjusted prevalence of the metabolic syndrome for adults is 23.7%.2

* One in three Americans born in 2000 will develop diabetes sometime during their lifetime.3

* Sixty four percent of adults are overweight and 31% are clinically obese.4

* Ten to fifteen percent of children in the United States are overweight, compared with 5% to 6% in 1976 to 1980.4

* More than 18 million Americans have diabetes, which is the sixth leading cause of death in America.3

* The number of US adults diagnosed with diabetes has increased 61% since 1991 and is projected to more than double by 2050.3

* An estimated 16 million US adults aged 40 to 74 years have prediabetes.3

* One of five adults older than 65 years has diabetes.3

* African American, Hispanic, American Indian, and Alaska Native adults are 2 to 3 times more likely than white adults to have diabetes.3

Experts are attributing the marked increase in the prevalence of obesity in both adults and children to a combination of factors, including increased energy intake coupled with reduction in activity levels.2-4 Clearly, the cardiovascular health risks are of primary concern as our nation continues to engage in behaviors which lead to the metabolic syndrome, stroke, and heart and kidney diseases.2

In addition to obesity, another alarming trend is the rise in the number of adults with high blood pressure, a key component of the metabolic syndrome. A recent study published in Hypertension noted that at least 65 million adults had hypertension in 1999 to 2000, which translates into a prevalence rate of 31.3%.5 This represented an overall increase of 30% in hypertensive adults from 1988 to 1994. Most US adults with hypertension comprised non-Hispanic white adults, although women, non-Hispanic black adults, and the elderly were important subgroups.5 This is not a condition associated with aging and "hardening of the arteries" anymore. Prehypertension and hypertension have been identified as critical issues for children and adolescents, attributed largely to marked increase in obesity among our nations' youth.2

There is some good news. Studies suggest that the progression from prediabetes to diabetes can be prevented or delayed. Lifestyle changes including modest weight loss and physical activity substantially reduced progression to diabetes among older adults who were at very high risk.3 National initiatives are underway to encourage healthier Americans. The National Institutes of Health, in a press release August 24, 2004, announced the Strategic Plan for NIH Obesity Research, which is program targeting and coordinating obesity research. This is in part a reflection of the prioritization of obesity within the US Department of Health and Human Services this year, characterizing it as an "epidemic that must be stopped."6 As a corollary to this initiative, Health and Human Services announced in July 2004 that Medicare has also modified language which would allow for coverage of scientifically supported treatments for obesity.7

It is paramount that cardiovascular nurses assume a leadership role in both the health care system and community by providing patient education, interventions, and research addressing the metabolic syndrome. This issue of The Journal of Cardiovascular Nursing provides an overview of emerging findings related to the metabolic syndrome, from identification to potential treatment strategies. The first article in this issue, "What is The Metabolic Syndrome: Prediabetes & Cardiovascular Risk" by Borgman et al outlines the current clinical consensus on the constellation of components which represent the metabolic syndrome. Key features, such as insulin resistance, obesity, hypertension, atherogenic dyslipidemia, and the protthrombotic and proinflammatory states, are summarized.

The next article by Schoenhagen and Nissen entitled "Identification of the Metabolic Syndrome and Subclinical Coronary Artery Disease: Early Markers of Cardiovascular Risk" provides a comprehensive overview of diagnostic strategies to detect the metabolic syndrome and the early manifestations of cardiovascular disease. This article focuses on techniques that can visualize the presence of subclinical cardiovascular disease before the onset of symptoms, including invasive and noninvasive measures of vascular reactivity and atherosclerotic plaque burden.

The impact of the metabolic syndrome on clinical outcomes is the focus of the third article by Bhatheja and Bhatt. The contribution of the components of the metabolic syndrome to coronary artery disease risk are reviewed and key clinical trials highlighted. The effect of the metabolic syndrome and diabetes on revascularization outcomes are summarized and possible treatment strategies proposed.

A comprehensive overview of the clinical management of the metabolic syndrome is provided by Cassells and Haffner, with a particular emphasis on treatment of cardiovascular risk management. The potential role of pharmacologic strategies are reviewed, with an emphasis on the current clinical trials.

The next article addresses the key controversies associated with current dietary trends in weight reduction, with particular emphasis on carbohydrate restriction. In "The Skinny on Low-Carbohydrate Diets: Are They Safe to Recommend to Patients," Ohlson reviews the current data on the popular carbohydrate reducing diets and provides guidance for clinical management of patients requiring weight loss strategies.

The issue concludes with a provocative article entitled "Changing Our Future: Overweight and the Metabolic Syndrome in Children and Adolescents." Harrell et al review the disturbing trends in the prevalence of overweight and obesity in children, highlighting the incidence of the metabolic syndrome even at this early age, and provide concrete recommendations for clinical practice.

This issue of The Journal of Cardiovascular Nursing addresses only a fraction of the advances within the scientific and lay communities related to the metabolic syndrome and the role of obesity and physical inactivity on development of cardiovascular disease and diabetes. As new studies identify key variables and interventions, it is incumbent upon nurses to keep abreast of the literature and apply the findings to patient and self-management.

Additional resources and guidelines to assist in the adoption of heart healthy, diabetes prevention behaviors can be found at http//:www.healthierus.gov/steps. Other resources for patient education (with access to multilingual patient education tools) include the following:

* http//:www.diabetes.org

* http//:www.americanheart.org

* http//:www.ndep.nih.gov

Ellen Strauss McErlean, MSN, RN, FAHA

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