The insulin resistance syndrome and coronary artery disease.
Insulin resistance is an increasingly common metabolic abnormality characterized by an impaired physiological response to insulin. The constellation of insulin resistance and several other metabolic and vascular disorders is known as the insulin resistance syndrome. The characteristic features of the insulin resistance syndrome include central obesity, hypertension, dyslipidemia, glucose intolerance and specific abnormalities of both endothelial cell and vascular function. Although insulin resistance can arise in response to aging, obesity and inactivity, there is a clear genetic component. Insulin resistance is not generally attributable to a single genetic defect. Indeed, it is very likely to be a polygenic disorder in most individuals. A genetic predisposition is suggested to be the demonstration of increased insulin resistance in first-degree relatives of patients with diabetes and by a high incidence of insulin resistance in specific populations. Epidemiological data have demonstrated a strong association between a clustering of specific factors and the risk of cardiovascular disease. The diagnosis of the insulin resistance syndrome remains a significant clinical challenge. At present, clinicians are faced with establishing a clinical diagnosis despite varying definitions of the disorder and controversy regarding how many components presage clinical events. A proposed approach to the management of patients with the insulin resistance syndrome is discussed.
Kendall
David M
DM
International Diabetes Center, Park Nicollet Clinic, 3800 Park Nicollet Blvd., St. Louis Park, MN 55416, USA. kendad@parknicollet.com
Sobel
Burton E
BE
Coulston
Ann M
AM
Peters Harmel
Anne L
AL
McLean
Barry K
BK
Peragallo-Dittko
Virginia
V
Buse
John B
JB
Fonseca
Vivian A
VA
Hill
James O
JO
Nesto
Richard W
RW
Sunyer
F Xavier Pi
FX
D003324:Coronary Artery Disease / Q000209:etiology* / Q000378:metabolism / Q000503:physiopathology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D006801:Humans; D024821:Metabolic Syndrome / Q000150:complications* / Q000378:metabolism / Q000503:physiopathology; D012307:Risk Factors