Today, the most logical explanation for this halt in the disease's tendency to regress, and even its progress, appears to be the existence beyond visible risk factors of a new threat known as metabolic syndrome (FIGURE III).

Up to now, it has been the visible part of the iceberg that has drawn all the attention: diagnosis and treatment focused on each of the disorders, often separately - diabetes, obesity, hypertension and cholesterol - but this conventional approach has undoubtedly reached its limit. We now need to switch from a vertical approach (by speciality) to a multidisciplinary horizontal approach.

It is now recognised that by studying the immersed part of the iceberg, one can characterise a large number of people who, although not ill, are suffering from several metabolic disorders: high blood pressure, disturbed lipid and sugar metabolism, and a tendency to be overweight. This combination, without any obvious illness, is what the Scientific Community call Metabolic Syndrome.

Many years ago it was recognised that a person's metabolic profile, which at that time was still poorly defined, can be very atherogenic (formation of atheroma plaques that block arteries). We know today that this is responsible for causing cardiovascular accidents such as myocardial infarction and angina pectoris, resulting in excess mortality.

Recent studies have demonstrated that patients suffering from Metabolic Syndrome are 3 times more likely to experience a cardiovascular accident than persons not presenting the syndrome.

In the face of this threat, we now consider it essential to go beyond the conventional risk factors and identify the population concerned by Metabolic Syndrome.