We concur with Dr. Varon that there is debate in the literature regarding both how to best define metabolic syndrome (MetS), as well as whether its combined components exert synergistic effects on atherosclerosis.1 However, our article is a concise summary of mainstream contemporary thought on the topic and was developed specifically for dentists so that when they are formulating risk assessments for middle-aged and older patients undergoing stress-provoking invasive dental procedures, they would be familiar with the concomitant cardiovascular risks given the prevalence of the disorder. Furthermore, the dental community needs to be aware of the pivotal role it plays in the management of the syndrome through preservation of a functional dentition.
On the basis of the aforementioned, we remain very comfortable with the results of our project and do not believe that a dental publication is an appropriate forum to debate the finite details of a most complex medical syndrome.
Between the date of publication of the 2005 Kahn and colleagues2 article cited by Dr. Varon and March 2007, PubMed, the research engine of the National Library of Medicine and National Institutes of Health, cited more than 3,500 newly published articles in which MetS was identified in the title, the abstract or both. The overwhelming majority of these publications adhered to the principles initially developed by the National Cholesterol Education Program Adult Treatment Panel III (ATP III),3 guidelines that we summarized in our February JADA article.
Today, the vast majority of the medical community continues to recognize that MetS is a clustering of simple clinical measures that identifies a substantial additional (synergistic) cardiovascular risk, on top of the individual risk factors, thereby predisposing patients to at least a doubling of the relative long-term risk for atherosclerosis and for cardiovascular disease.4
In the first three months of this year, major research projects have confirmed the utility and importance of this diagnostic construct by demonstrating that MetS predicts a statistically significant increase in arterial stiffness,5 altered structure of the carotid arteries,6 altered structure and function of the left ventricle,7,8 cardiac dysrhythmias,9 congestive heart failure10 and adverse cardiovascular events (myocardial infarct and stroke).11,12
Furthermore, our article accurately and comprehensively documents the relationship between orofacial health and disease and atherogenic risk factors (for example, an impaired dentition and ingestion of a diet associated with increased risk of cardiovascular disease).
Lastly, the adverse effects of MetS on oral health are just now coming to the fore, as evidenced by a recent study demonstrating an increased risk of developing periodontitis.13
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