The “New Deadly Quartet” for Cardiovascular Disease in the 21st Century: Obesity, Metabolic Syndrome, Inflammation and Climate Change: How Does Statin Therapy Fit into this Equation?

  • Michael Clearfield
  • Melissa Pearce
  • Yasmin Nibbe
  • David Crotty
  • Alesia Wagner
Statin Drugs (MB Clearfield, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Statin Drugs


Despite population-based improvements in cardiovascular risk factors, such as blood pressure, cholesterol and smoking, cardiovascular disease still remains the number-one cause of mortality in the United States. In 1989, Kaplan coined the term “Deadly Quartet” to represent a combination of risk factors that included upper body obesity, glucose intolerance, hypertriglyceridemia and hypertension [Kaplan in Arch Int Med 7:1514–1520, 1989]. In 2002, the third report of the National Cholesterol Education Program Adult Treatment Panel (NCEP-ATP III) essentially added low HDL-C criteria and renamed this the “metabolic syndrome.” [The National Cholesterol Education Program (NCEP) in JAMA 285:2486–2497, 2001] However, often forgotten was that a pro-inflammatory state and pro-thrombotic state were also considered components of the syndrome, albeit the panel did not find enough evidence at the time to recommend routine screening for these risk factors [The National Cholesterol Education Program (NCEP) in JAMA 285:2486–2497, 2001]. Now over a decade later, it may be time to reconsider this deadly quartet by reevaluating the roles of obesity and subclinical inflammation as they relate to the metabolic syndrome. To complete this new quartet, the addition of increased exposure to elevated levels of particulate matter in the atmosphere may help elucidate why this cardiovascular pandemic continues, despite our concerted efforts. In this article, we will summarize the evidence, focusing on how statin therapy may further impact this new version of the “deadly quartet”.


Metabolic syndrome/obesity Subclinical inflammation Air pollution/climate change Statin/pharmacology Prevention/cardiovascular risk 


Compliance with Ethics Guidelines

Conflict of Interest

Michael Clearfield is a consultant to, received honoraria from, and had travel/accommodations expenses covered or reimbursed by Astra Zeneca and Daiichi Sankyo.

Melissa Pearce declares no conflict of interest.

Yasmin Nibbe declares no conflict of interest.

David Crotty declares no conflict of interest.

Alesia Wagner declares no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Michael Clearfield
    • 1
  • Melissa Pearce
    • 1
  • Yasmin Nibbe
    • 1
  • David Crotty
    • 1
  • Alesia Wagner
    • 1
  1. 1.Touro University College of Osteopathic MedicineVallejoUSA

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