Insulin resistance and the metabolic syndrome as predictors of cardiovascular risk: where are we now?
Interest in insulin resistance as a candidate pathway in the pathogenesis of vascular disease continues to grow, in part fuelled by the rapidly increasing rates of obesity worldwide which drives insulin resistance in susceptible individuals. Insulin resistance is associated with a range of metabolic perturbances and many of these can accelerate the atherogenic process. There is thus considerable clinical interest in assessing the degree of insulin resistance in subjects at risk for vascular disease. Direct measurements of insulin resistance are generally unsuitable for widespread clinical use. Rather metabolic syndrome criteria based on readily measured factors associated insulin resistance have been proposed by the World Health Organisation and the National Cholesterol Education Panel. Although such criteria predict coronary heart disease events and more strongly type 2 diabetes, their clinical applicability requires much more study. One recent benefit, however, is that vascular risk physicians now more frequently document obesity and glucose concentrations in their patients, and more commonly consider lifestyle interventions. Ongoing clinical trials will further determine the value of lifestyle factors and insulin sensitising agents in reducing risk of vascular and metabolic disease in high risk subjects.
Sattar
N
N
Division of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK. nsattar@clinmed.gla.ac.uk
D002318:Cardiovascular Diseases / Q000209:etiology* / Q000517:prevention & control; D006801:Humans; D007333:Insulin Resistance; D024821:Metabolic Syndrome / Q000150:complications* / Q000209:etiology / Q000628:therapy; D012307:Risk Factors