Abstract
The metabolic syndrome consists of a cluster of metabolic disorders, many of which
promote the development of atherosclerosis and increase the risk of cardiovascular
disease events. Insulin resistance may lie at the heart of the metabolic syndrome.
Elevated serum triglycerides commonly associate with insulin resistance and represent
a valuable clinical marker of the metabolic syndrome. Abdominal obesity is a clinical
marker for insulin resistance. The metabolic syndrome manifests 4 categories of abnormality:
atherogenic dyslipidemia (elevated triglycerides, increased small low-density lipoproteins,
and decreased high-density lipoproteins), increased blood pressure, elevated plasma
glucose, and a prothrombotic state. Various therapeutic approaches for the patient
with the metabolic syndrome should be implemented to decrease the risk of cardiovascular
disease events. These interventions include decreasing obesity, increasing physical
activity, and managing dyslipidemia; the latter may require the use of pharmacotherapy
with cholesterol-lowering and triglyceride-lowering drugs.
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References
- Hypertriglyceridemia, atherogenic dyslipidemia, and the metabolic syndrome.Am J Cardiol. 1998; 81: 18B-25B
- Coronary heart disease in high-risk populations.Eur Heart J. 1990; 11: 462-471
National Heart, Lung, and Blood Institute. Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. The Evidence Report. Bethesda, Md: National Institutes of Health; 1968.
- Familial dyslipidaemic hypertension and other multiple metabolic syndromes.Ann Med. 1992; 24: 469-475
- Increased plasma plasminogen activator inhibitor 1 levels. A possible link between insulin resistance and atherothrombosis.Diabetologia. 1991; 34: 457-462
- Impaired glucose tolerance.in: LeRoith D. Taylor S.I. Olefsky J.M. Diabetes Mellitus. A Fundamental and Clinical Text. Lippincott-Raven Publishers, Philadelphia1996: 467-474
- Quantification of coronary artery calcium using ultrafast computed tomography.J Am Coll Cardiol. 1990; 15: 827-832
- Pathophysiology of insulin resistance in human disease.Physiol Rev. 1995; 75: 473-486
- Insulin resistance. A multifaceted syndrome responsible for NIDDM, obesity, hypertension, dyslipidemia and atherosclerotic cardiovascular disease.Diabetes Care. 1991; 14: 173-194
- Effects of varying carbohydrate content of diet in patients with noninsulin-dependent diabetes mellitus.JAMA. 1994; 271: 1421-1428
- Characterization of the insulin resistance of aging.J Clin Invest. 1983; 71: 1581-1587
- Abnormal glucocorticoid activity in subjects with risk factors for cardiovascular disease.Endocr Res. 1996; 22: 701-708
- Insulin resistance and the polycystic ovary syndrome.Endocr Rev. 1997; 18: 774-800
- Role of insulin resistance in adipose tissue and liver in the pathogenesis of endogenous hypertriglyceridemia in man.Diabetologia. 1976; 12: 563-571
- Hyperinsulinaemia and hypertriglyceridaemia.J Intern Med Suppl. 1994; 736: 23-26
- The insulin resistance-dyslipidemic syndrome of visceral obesity.Obes Res. 1998; 6: 8S-17S
- Abnormal metabolism of free fatty acids in hypertriglyceridaemic men.J Intern Med. 1998; 243: 265-274
- Influence of body fat distribution on free fatty acid metabolism in obesity.J Clin Invest. 1989; 83: 1168-1173
- Apolipoprotein B metabolism in subjects with deficiency of apolipoproteins CIII and AI. Evidence that apolipoprotein CIII inhibits catabolism of triglyceride-rich lipoproteins by lipoprotein lipase in vivo.J Clin Invest. 1986; 78: 1287-1295
- Inhibitory effects of C apolipoproteins from rats and humans on the uptake of triglyceride-rich lipoproteins and their remnants by the perfused rat liver.J Lipid Res. 1985; 26: 556-565
- Small, dense low-density lipoproteins, the insulin resistance syndrome and noninsulin-dependent diabetes.Curr Opin Lipidol. 1996; 7: 167-171
- A preponderance of small dense LDL is associated with specific insulin, proinsulin and the components of the insulin resistance syndrome in non-diabetic subjects.Diabetologia. 1995; 38: 1328-1336
- Isolated low HDL cholesterol. An insulin-resistance state.Diabetes. 1994; 43: 411-417
- Insulin resistance in hypertension.Am J Med Sci. 1993; 306: 345-347
- Insulin resistance and hypertension.Mol Cell Endocrinol. 1990; 74: C87-C89
- Hypertension and associated metabolic abnormalities—the role of insulin resistance and the sympathoadrenal system.N Engl J Med. 1996; 334: 374-381
- Hypertension, dyslipidemia, and insulin resistance.Curr Opin Lipidol. 1996; 7: 241-253
- Familial dyslipidemic hypertension. Evidence from 58 Utah families for a syndrome present in approximately 12% of patients with essential hypertension.JAMA. 1988; 259: 3579-3586
- Metabolic disturbances in hypertension: results from the population study “men born in 1913.”.J Intern Med. 1992; 232: 389-395
- Prediction of coronary heart disease using risk factor categories.Circulation. 1998; 97: 1837-1847
- Lipoproteins and the haemostatic system in atherothrombotic disorders.Baillieres Clin Haematol. 1994; 7: 713-732
- Very-low-density lipoprotein response element in the promoter region of the human plasminogen activator inhibitor-1 gene implicated in the impaired fibrinolysis of hypertriglyceridemia.Arterioscler Thromb Vasc Biol. 1998; 18: 20-26
- Hypertriglyceridemia, but not hypercholesterolemia, is associated with the alterations of fibrinolytic system.Horm Metab Res. 1996; 28: 603-606
- Serum triglycerides and blood coagulation factors VII and X, and plasminogen activator inhibitor-1.J Atheroscler Thromb. 1995; 2: S41-S46
- Relationship between plasma plasminogen activator inhibitor-1 activity and VLDL triglyceride concentration, insulin levels and insulin sensitivity.Diabetologia. 1993; 36: 817-825
- Investigations into the haemorheological significance of postprandial and fasting hypertriglyceridaemia.Eur J Clin Invest. 1993; 23: 270-276
- The cardiovascular risk factor plasminogen activator inhibitor type 1 is related to insulin resistance.Metabolism. 1993; 42: 945-949
- Insulin sensitivity is not an independent determinant of plasma plasminogen activator inhibitor-1 activity.Arterioscler Thromb. 1994; 14: 1264-1271
- Hypofibrinolysis and the insulin resistance syndrome.Int J Obes Relat Metab Disord. 1995; 19: S11-S15
- Insulin resistance syndrome and fibrinolytic activity.Int J Epidemiol. 1996; 25: 291-299
- PAI-1, obesity, insulin resistance and risk of cardiovascular events.Thromb Haemost. 1997; 78: 656-660
- Weight loss reduces abdominal fat and improves insulin action in middle-aged and older men with impaired glucose tolerance.Metabolism. 1995; 44: 1502-1508
- Improvement of insulin sensitivity contributes to blood pressure reduction after weight loss in hypertensive subjects with obesity.Hypertension. 1996; 27: 1180-1186
- The benefits of modest weight loss in type II diabetes.Int J Obes Relat Metab Disord. 1997; 21: S10-S13
- Diet and exercise in the treatment of obesity.Arch Intern Med. 1998; 158: 2477-2483
- Improvements in blood pressure, glucose metabolism, and lipoprotein lipids after aerobic exercise plus weight loss in obese, hypertensive middle-aged men.Metabolism. 1998; 47: 1075-1082
- The determinants of glycemic responses to diet restriction and weight loss in obesity and NIDDM.Diabetes Care. 1998; 21: 687-694
- Changes in insulin sensitivity, glucose effectiveness, and β-cell function in regularly exercising subjects.Metabolism. 1995; 44: 1259-1263
- Distinct effects of aerobic exercise training and weight loss on glucose homeostasis in obese sedentary men.J Appl Physiol. 1996; 81: 318-325
- Exercise training reverses insulin resistance in muscle by enhanced recruitment of GLUT-4 to the cell surface.Am J Physiol. 1997; 272: E864-E869
- Improvement of insulin sensitivity by short-term exercise training in hypertensive African American women.Hypertension. 1997; 30: 1549-1553
- Glucose tolerance is improved after low- and high-intensity exercise in middle-age men and women.Can J Appl Physiol. 1998; 23: 583-593
- Exercise, glucose transport, and insulin sensitivity.Annu Rev Med. 1998; 49: 235-261
- Intensity and amount of physical activity in relation to insulin sensitivity.JAMA. 1998; 279: 669-674
- Increased glucose transport-phosphorylation and muscle glycogen synthesis after exercise training in insulin-resistant subjects.N Engl J Med. 1996; 335: 1357-1362
- Thiazolidinediones.Endocrinol Metab Clin North Am. 1997; 26: 553-573
- Two cases of severe clinical and histologic hepatotoxicity associated with troglitazone.Ann Intern Med. 1998; 129: 36-38
- Troglitazone-induced hepatic failure leading to liver transplantation.Ann Intern Med. 1998; 129: 38-41
- Fatal hepatotoxicity associated with troglitazone.Ann Intern Med. 1998; 129: 1080
- Relation between baseline lipid and lipoprotein values and the incidence of coronary heart disease in the Helsinki Heart Study.Am J Cardiol. 1989; 63: 42H-47H
- Reduction of mortality in the Stockholm ischaemic heart disease secondary prevention study to combined treatment with clofibrate and nicotinic acid.Acta Med Scand. 1988; 223: 405-418
Kaplinsky E. The Bezabifrate Infarction Prevention Study. Preliminary results presented at the annual meeting of the European Society of Cardiology, Vienna, August 1998.
- Management of primary mixed hyperlipidemia with lovastatin.Arch Intern Med. 1990; 150: 1313-1319
Article Info
Publication History
Published online: August 16, 2004
Identification
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© 1999 Excerpta Medica Inc. Published by Elsevier Inc. All rights reserved.
