Metabolic syndrome and cardiovascular disease

Abstract

The clustering of metabolic and pathophysiological cardiovascular risk factors has long been recognized but it was Reaven who popularized the syndrome in the Banting lecture of 1988. Since 1999, several major international or national organizations proposed their own definitions for the syndrome, named the metabolic syndrome. The prevalence of the metabolic syndrome varies according to definition, ethnicity and gender. The prevalence is under 20% among Chinese and Korean people but over 50% among Maori and Pacific Islanders in New Zealand. People with the metabolic syndrome have 50-60% higher cardiovascular risk than those without. The absolute cardiovascular risk of the metabolic syndrome, however, is not necessarily higher than those of its individual components. The pathogenesis underlying the clustering of cardiovascular risk factors remains unclear. Factors including genetic disposition, obesity, insulin resistance and inflammation have been suggested as being involved. Since the metabolic syndrome is multifactorial in origin, strategies for reducing cardiovascular risk in individuals with the metabolic syndrome involve the management of multiple risks. Lifestyle changes are an effective first-line management; pharmacological interventions for hypertension, diabetes and dyslipidaemia are in accordance with established guidelines. Pharmacological and surgical therapies for obesity are effective in selected patients. In this article we discuss the definitions, prevalence, pathogenesis and management of the metabolic syndrome in relation to cardiovascular risk.

Genetic and environmental influences on factors associated with cardiovascular disease and the metabolic syndrome

“…Waist circumference, plasma glucose, plasma triglyceride concentration, and diastolic blood pressure were linked through a common latent factor, which was estimated to be 53% heritable but was statistically signifi cantly infl uenced by both genetic and common environmental factors. We speculate that this common factor is related to insulin resistance, a previously proposed underlying cause of MetS ( 75 ). It has been suggested that insulin resistance leads to hyperglycemia by decreasing glucose uptake in muscle ( 76 ), dyslipidaemia (low HDL cholesterol and high triglyceride concentration) caused by an increase of free fatty acids transported environmental infl uences that are specifi c to the individual.…”

The proinflammatory phenotype of PECAM-1-deficient mice results in atherogenic diet-induced steatohepatitis

“…These findings suggest that PECAM-1 plays a role in the development of cardiovascular disease in humans. Since recent studies have led to the conclusion that the factors that predispose for development of cardiovascular disease are also risk factors for development of NASH (6,11,35,40,54,56,66), it will be important in future studies to determine whether any of the PECAM-1 SNPs or alleles are associated with an increased propensity to develop severe NAFLD.…”

Chromium and polyphenols from cinnamon improve insulin sensitivity

“…88 m for women. The incidence of the metabolic syndrome varies from <20% among the Chinese and Korean populations to > 50% among Maori and Pacific Islanders in New Zealand (2) . Approximately one in four Americans has the metabolic syndrome.…”