An update on cardiovascular risk of metabolic syndrome

Abstract

Efforts are being made to identify cardiovascular (CV) risk factors (RF) and intervene in high-risk subjects aiming to reduce CV mortality. Disorders grouped under the metabolic syndrome (MS), linked by insulin resistance (IR), confer high CV risk due to the cluster of glucose intolerance, hypertension, elevated triglycerides and low HDL-cholesterol levels in addition to several recently described RF. Hyperinsulinemia is considered an independent RF; central obesity is associated with major RF independently of BMI. High visceral fat lipolytic activity results in overproduction of free fatty acids and metabolic consequences, characterizing the IR state. Association of microalbuminuria with hypertension, triglyceride and fibrinogen levels suggested a role in predicting CV disease. It should be considered a marker of generalized endothelial dysfunction. Hypofibrinolysis due to fibrinogen and PAI-1 elevations, induced by the IR state, facilitates atherothrombosis in patients with MS. The thrombin activator fibrinolysis inhibitor is also independently associated with markers of obesity, glycated hemoglobin and IR. Hyper-homocystinemia is associated with deleterious vessel effects and seems to be result from endothelial damage, chronic inflammatory status and kidney impairment. C-reactive protein and adiponectin - sensitive markers of inflammation - are also associated with IR. Endothelin-1 can lead to MS disorders and increased production might reflect endothelial damage caused by IR. In summary, patients with MS are at the highest risk of dying from CV events. Interventional trials directed to components of MS and also to increase insulin sensitivity are needed to establish the prognostic impact in CV morbidity and mortality.

Tissue-specific adaptive levels of glucocorticoid receptor alpha mRNA and their relationship with insulin resistance

“…Cardiovascular events are among the most common causes of death and are frequently related to coronary artery disease (CAD) (Rosenbaum and Ferreira, 2003). Insulin resistance (IR) and concomitant hyperinsulinemia are implicated in the pathophysiology of metabolic syndrome (MS) including endothelial dysfunction (Bansilal et al, 2007) and are associated with hypertension, dyslipidemia, visceral obesity, altered glucose metabolism, and inflammatory and prothrombotic states (Reaven, 2008).…”

The Prevalence of Metabolic Syndrome Among Soldiers of the Military Police of Bahia State, Brazil

“…Metabolic syndrome (MS) encompass a group of cardiovascular risk factors such as dyslipidemia (including increased triglycerides and reduced high-density lipoprotein [HDL] cholesterol levels), abnormal glucose metabolism (elevated fasting glucose), hypertension, and central obesity (characterized primarily by an increased waist circumference). All of these clinical conditions are superimposed on insulin resistance (usually manifested as hyperinsulinemia and altered glucose metabolism, with metabolic consequences; 1 Federal University of Bahia, Salvador, Brazil (Rosenbaum & Ferreira, 2003). A population-based study, conducted in a capital city in northeast Brazil, randomly sampled 1,663 individuals aged between 25 and 64 years and found the prevalence of MS in this population to be 29.8%.…”

Influência do excesso de peso corporal e da adiposidade central na glicemia e no perfil lipídico de pacientes portadores de diabetes mellitus tipo 2

“…Por esse mecanismo, ocorreria maior liberação de ácidos graxos não esterificados na corrente sanguínea a partir dos adipócitos viscerais, maior captação de ácidos graxos pelo fígado, aumento na produção de VLDL, substrato para a gliconeogênese e, como resultado final, um estado de hipertrigliceridemia e hiperglicemia (25,26).…”