Metabolic syndrome and vascular disease: is nature or nurture leading the new epidemic of cardiovascular disease?

Abstract

Whereas the previous epidemic of coronary heart disease (CHD) between 1910 and the 1960s was largely attributed to increased intake of saturated fat, it is quite plausible that the current epidemic of obesity and metabolic syndrome (MS) will lead the new epidemic of CHD, not only in the United States but throughout the world. During the previous epidemic, the populations of the Western and industrialized nations were those predominantly affected; however, on the basis of the fact that obesity is reaching epidemic proportions in most parts of the world, the new epidemic of CHD related to obesity and MS is likely to impose an unprecedented global burden of cardiovascular (CV) disease (CVD). Although the precise reason for the global epidemic of obesity and MS has not been established, there is general agreement that environmental factors and changes in lifestyle are major contributors. It is thought that common changes in people’s behavior, which lead to consumption of high-calorie, refined food in association with decreased levels of physical activity, are largely responsible for obesity and MS. Because of their strong association with CVD, both obesity and MS are major public health problems. See p 42 Because MS is associated with increased risk of CHD, it has also been called the “Deadly Quartet” or cardiovascular dysmetabolic syndrome.1,2 MS comprises a cluster of abnormalities that occur as a result of perturbations in multiple metabolic pathways, leading to hyperinsulinemia, insulin resistance (IR), hyperglycemia, atherogenic dyslipidemia, and hypertension. Recent findings also suggest that MS is a proinflammatory condition, as characterized by elevations of serum high-sensitivity C-reactive protein.3,4 There is now evidence that several atherothrombotic factors also are increased in MS; these include increased levels of plasminogen activator inhibitor-1, serum fibrinogen, von Willebrand factor, factor VII, and thrombin, as well as increased platelet activation and …