Current Diabetes Reports

, Volume 4, Issue 1, pp 26–30 | Cite as

Are there specific components of the insulin resistance syndrome that predict the increased atherosclerosis seen in type 2 diabetes mellitus?

  • Sherita Hill Golden
  • Rachel Chong
Article

Abstract

Cardiovascular disease is often present in patients with newly diagnosed type 2 diabetes. It is hypothesized that both type 2 diabetes and cardiovascular disease arise from an underlying insulin resistance syndrome, including impaired glucose tolerance, hypertension, dyslipidemia, and abdominal obesity. We reviewed the literature using various epidemiologic techniques to evaluate the relation between the insulin resistance syndrome components and incident cardiovascular disease. We found that although insulin resistance is likely important in the development of cardiovascular disease seen in diabetes, lipid and blood pressure abnormalities associated with the syndrome appear to be equally important. Future studies are needed to determine the most effective treatment strategies for preventing cardiovascular disease associated with the insulin resistance syndrome and type 2 diabetes.

Keywords

Insulin Resistance Metabolic Syndrome Impaired Glucose Tolerance National Cholesterol Education Program Insulin Resistance Syndrome 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
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References and Recommended Reading

  1. 1.
    King H, Aubert RE, Herman WH: Global burden of diabetes, 1995–2025: prevalence, numerical estimates, and projections. Diabetes Care 1998, 21:1414–1431.PubMedCrossRefGoogle Scholar
  2. 2.
    Haffner SM, Stern MP, Hazuda HP, et al.: Cardiovascular risk factors in confirmed prediabetic individuals. Does the clock for coronary heart disease start ticking before the onset of clinical diabetes? JAMA 1990, 263:2893–2898.PubMedCrossRefGoogle Scholar
  3. 3.
    Stern MP: Do non-insulin-dependent diabetes mellitus and cardiovascular disease share common antecedents? Ann Intern Med 1996, 1241 Pt 2):110–116.PubMedGoogle Scholar
  4. 4.
    Haffner SM, Mykkanen L, Festa A, etal.: Insulin-resistant prediabetic subjects have more atherogenic risk factors than insulin-sensitive prediabetic subjects: implications for preventing coronary heart disease during the prediabetic state. Circulation 2000, 101:975–980.PubMedGoogle Scholar
  5. 5.
    Reaven GM: Role of insulin resistance in human disease. Diabetes 1988, 37:1595–1607.PubMedCrossRefGoogle Scholar
  6. 6.
    Liese AD, Mayer-Davis EJ, Chambless LE, et al.: Elevated fasting insulin predicts incident hypertension: the ARIC study. Atherosclerosis Risk in Communities Study Investigators. J Hypertens 1999, 17:1169–1177.PubMedCrossRefGoogle Scholar
  7. 7.
    Meigs JB, D'Agostino RB Sr, Wilson PW, et al.: Risk variable clustering in the insulin resistance syndrome. The Framingham Offspring Study. Diabetes 1997, 46:1594–1600.PubMedCrossRefGoogle Scholar
  8. 8.
    Nabulsi AA, Folsom AR, Heiss G, et al.: Fasting hyperinsulinemia and cardiovascular disease risk factors in nondiabetic adults: stronger associations in lean versus obese subjects. Atherosclerosis Risk in Communities Study Investigators. Metabolism 1995, 44:914–922.PubMedCrossRefGoogle Scholar
  9. 9.
    Haffner SM, D'Agostino RJr, Mykkanen L, et al.: Insulin sensitivity in subjects with type 2 diabetes. Relationship to cardiovascular risk factors: the Insulin Resistance Atherosclerosis Study. Diabetes Care 1999, 22:562–568.PubMedCrossRefGoogle Scholar
  10. 10.
    UK Prospective Diabetes Study (UKPDS). VIII. Study design, progress and performance [no authors listed]. Diabetologia 1991, 34:877–890.Google Scholar
  11. 11.
    Lakka HM, Laaksonen DE, Lakka TA, et al.: The metabolic syndrome and total and cardiovascular disease mortality in middle-aged men. JAMA 2002, 288:2709–2716. An excellent prospective analysis of multiple definitions of the insulin resistance syndrome, including the NCEP and WHO criteria, that demonstrates increased cardiovascular and total mortality in individuals with the syndrome.PubMedCrossRefGoogle Scholar
  12. 12.
    Golden SH, Wang N, Klag MJ, et al.: Blood pressure in young adulthood and the risk of type 2 diabetes in middle age. Diabetes Care 2003, 26:1110–1115.PubMedCrossRefGoogle Scholar
  13. 13.
    Golden SH, Folsom AR, Coresh J, et al.: Risk factor groupings related to insulin resistance and their synergistic effects on subclinical atherosclerosis. The Atherosclerosis Risk in Communities Study. Diabetes 2002, 51:3069–3076. This study examined all possible combinations of six insulin resistance syndrome components in relation to atherosclerosis, and demonstrated a synergistic effect of the insulin resistance syndrome beyond the additive effects of the individual components.PubMedCrossRefGoogle Scholar
  14. 14.
    Meigs JB: Invited commentary: insulin resistance syndrome? syndrome X? Multiple metabolic syndrome? A syndrome at all? Factor analysis reveals patterns in the fabric of correlated metabolic risk factors. Am J Epidemiol 2000, 152:908–911.PubMedCrossRefGoogle Scholar
  15. 15.
    Lempiainen P, Mykkanen L, Pyorala K, et al.: Insulin resistance syndrome predicts coronary heart disease events in elderly nondiabetic men. Circulation 1999, 100:123–128.PubMedGoogle Scholar
  16. 16.
    Lehto S, Ronnemaa T, Pyorala K, Laakso M: Cardiovascular risk factors clustering with endogenous hyperinsulinemia predict death from coronary heart disease in patients with type II diabetes. Diabetologia 2000, 43:148–155.PubMedCrossRefGoogle Scholar
  17. 17.
    Pyorala M, Miettinen H, Halonen P, et al.: Insulin resistance syndrome predicts the risk of coronary heart disease and stroke in healthy middle-aged men: the 22-year follow-up results of the Helsinki Policemen Study. Arterioscler Thromb Vasc Biol 2000, 20:538–544.PubMedGoogle Scholar
  18. 18.
    Hanson RL, Imperatore G, Bennett PH, Knowler WC: Components of the "metabolic syndrome" and incidence of type 2 diabetes. Diabetes 2002, 51:3120–3127.PubMedCrossRefGoogle Scholar
  19. 19.
    Reaven GM: Insulin resistance/compensatory hyperinsulinemia, essential hypertension, and cardiovascular disease. J Clin Endocrinol Metab 2003, 88:2399–2403.PubMedCrossRefGoogle Scholar
  20. 20.
    Mokdad AH, Bowman BA, Ford ES, et al.: The continuing epidemics of obesity and diabetes in the United States. JAMA 2001, 286:1195–1200.PubMedCrossRefGoogle Scholar
  21. 21.
    Ford ES, Giles WH, Dietz WH: Prevalence of the metabolic syndrome among US adults. JAMA 2002, 287:356–359.PubMedCrossRefGoogle Scholar
  22. 22.
    Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults: Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA 2001, 285:2486–2497.CrossRefGoogle Scholar
  23. 23.
    Pan X, Li G, Hu Y, et al.: Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance. The Da Qing IGT and Diabetes Study. Diabetes Care 1997, 20:537–544.PubMedCrossRefGoogle Scholar
  24. 24.
    Tuomilehto J, Lindstrom J, Eriksson J, et al.: Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med 2001, 344:1343–1350.PubMedCrossRefGoogle Scholar
  25. 25.
    Knowler WC, Barrett-Connor E, Fowler SE, et al.: Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002, 346:393–403.PubMedCrossRefGoogle Scholar
  26. 26.
    Buchanan TA, Xiang AH, Peters RK, et al.: Preservation of pancreatic beta-cell function and prevention of type 2 diabetes by pharmacological treatment of insulin resistance in high-risk Hispanic women. Diabetes 2002, 51:2796–2803.PubMedCrossRefGoogle Scholar

Copyright information

© Current Science Inc 2004

Authors and Affiliations

  • Sherita Hill Golden
    • 1
  • Rachel Chong
  1. 1.Division of Endocrinology and MetabolismJohns Hopkins University School of MedicineBaltimoreUSA

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