title: Syndrome W: a new model of hyperinsulinemia, hypertension and midlife weight gain in healthy women with normal glucose tolerance.
abstract: To characterize a new insulin resistance syndrome in euglycemic midlife women and the relationship of its features (including hypertension and dyslipidemia), with hyperinsulinemia (AUC insulin > or = 100 microU/mL), retrospective cohort analysis was conducted in 278 consecutive women who presented to a Menopausal Health Program. Of 67 women with midlife weight gain "greater than 20 pounds since their twenties" and body mass indices (BMIs) between 25 and 32 kg/m(2), none of the subjects met criteria for Type 2 diabetes, 5 women had impaired glucose tolerance, and 36 women were hyperinsulinemic. Hyperinsulinemia was a highly statistically significant determinant of hypertension, dyslipidemia, and truncal obesity (Odds Ratios 10.6, 4.0, and 13.7; P values < or = 0.0001, < or = 0.007, and < or = 0.0001) in cross-tabulations. AUC insulin was the best predictor variable of hypertension and dyslipidemia in univariate and multivariate logistic regression models (univariate P values 0.0004 and 0.0088). After adjustment for BMI, age, and estrogen use, the final models, correctly classified, respectively, 74% and 69% of all cases in the dataset (model P values: < or = 0.0001 and < or = 0.0067) and AUC insulin had a log-linear (i.e., dose-dependent) relationship with hypertension and dyslipidemia, which suggests causality. We propose that the constellation of symptoms that includes midlife weight gain, "waist-gain," hypertension, dyslipidemia, and appetite dysregulation in euglycemic women with hyperinsulinemia be titled Syndrome W and suggest that the highly statistically significant relationship of hyperinsulinemia with the characteristic features are evidence of a causal role for insulin in its etiology. The identification of Syndrome W before the onset of overt impaired glucose tolerance, diabetes, or manifestations of coronary artery disease could have important clinical and public health implications for midlife women.
authors.affiliation: Division of Endocrinology, Department of Medicine, New York Medical College, Valhalla, New York 10595, USA. hrmogul@nymc.edu
authors.forename: Harriette R
authors.initials: HR
authors.lastname: Mogul
authors.forename: Bernard I
authors.initials: BI
authors.lastname: Weinstein
authors.forename: Douglas B
authors.initials: DB
authors.lastname: Mogul
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Peterson
authors.forename: Shaochun
authors.initials: S
authors.lastname: Zhang
authors.forename: Michael
authors.initials: M
authors.lastname: Frey
authors.forename: Steven R
authors.initials: SR
authors.lastname: Gambert
authors.forename: A Louis
authors.initials: AL
authors.lastname: Southren
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D019540:Area Under Curve; D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure / Q000502:physiology; D015992:Body Mass Index; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications; D005260:Female; D005951:Glucose Tolerance Test; D006801:Humans; D006946:Hyperinsulinism / Q000097:blood / Q000150:complications; D006973:Hypertension / Q000097:blood / Q000150:complications; D016014:Linear Models; D016015:Logistic Models; D024821:Metabolic Syndrome / Q000502:physiology*; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D011237:Predictive Value of Tests; D012016:Reference Values; D012189:Retrospective Studies; D014280:Triglycerides / Q000097:blood; D015430:Weight Gain / Q000502:physiology; D016387:Women's Health
chemical_list: D001786:Blood Glucose; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D014280:Triglycerides