May be a guidepost or detour to preventing type 2 diabetes and cardiovascular disease Type 2 diabetes mellitus is becoming extremely common; its prevalence worldwide is expected to reach 5-7.6% by 2025.1 Atherosclerotic cardiovascular disease is the principal cause of death, disability, and excess healthcare costs in diabetes. Cardiovascular disease may already be present at the time when diabetes is diagnosed,w1 and patients with diabetes are more likely than their non-diabetic counterparts to die from a first event of cardiovascular disease.w2 These realities point to prevention of type 2 diabetes as the route to prevention of its costliest complications. The close association of type 2 diabetes with cardiovascular disease led to the hypothesis that the two arise from a common antecedent;w3 this concept has been codified by the World Health Organization and others as “the metabolic syndrome.”2 The diagnosis of the metabolic syndrome in patients might hold promise for enhanced prevention of diabetes and cardiovascular disease. However, substantial uncertainties remain about the clinical definition of the syndrome and whether risk factor clusters collectively indicate a discrete, unifying disorder. Most importantly, it is unclear whether diagnosing …