Manipulating the vascular biology of coronary atherosclerosis in diabetes: New opportunities

Abstract

More than 7 million people in the United States of America have diabetes mellitus, and type 2 diabetes and the insulin resistance syndrome are increasingly prevalent. This is thought to be the result of the aging of the population, the increasing prevalence of obesity, the growing contribution of high-risk minority groups, and a lower glycemic threshold for the diagnosis of diabetes. The insulin resistance syndrome (syndrome X) describes the clustering of a number of metabolic abnormalities that are risk factors for both diabetes mellitus and atherosclerotic cardiovascular disease. 1 Haffner SM. The insulin resistance syndrome revisited. Diabetes Care. 1996; 19: 275-277 Google Scholar These risk factors include hyperinsulinemia, impaired glucose tolerance, hypertension, and a characteristic dyslipidemia (Table I). 2 Stamler J Vaccaro O Neaton JD Wentworth D. Diabetes, other risk factors, and 12-year cardiovascular mortality for men screened in the multiple risk factor intervention trial. Diabetes Care. 1993; 16: 434-444 Google Scholar Table IInsulin resistance syndrome (syndrome X) Original description Hyperinsulinemia Impaired glucose tolerance Hypertension Increased triglycerides Decreased HDL cholesterol Extensions Visceral adiposity Small dense LDL cholesterol Increased plasminogen activator inhibitor-1 Decreased sex hormone binding globulin Post-prandial lipemia Open table in a new tab An alternative name, the cardiovascular dysmetabolic syndrome , has been proposed in an effort to emphasize the cardiovascular consequences of this syndrome (Table II). 3 Fagan TC Deedwania PC. The cardiovascular dysmetabolic syndrome. Am J Med. 1998; 105: 77S-82S Google Scholar Table IICardiovascular dysmetabolic syndrome D I. Dyslipidemia Fasting triglycerides >140 mg/dL or HDL cholesterol <40 mg/dL or LDL particle size <260A R II. Insulin resistance Fasting plasma glucose ≥119 mg/dL or Type 2 diabetes mellitus O III. Obesity Body mass index >25 kg/m2 or Waist/hip >0.85 or Waist >100 cm P IV. High blood pressure Systolic blood pressure ≥140 mm Hg or Diastolic blood pressure ≥90 mm Hg Open table in a new tab