Mechanism of the deadly quartet

A deadly quartet of risk factors places diabetics at a particularly high risk for adverse cardiovascular events; these factors are hypertension, hyperlipidemia, hyperglycemia and hyperinsulinemia. A number of metabolic abnormalities are common to diabetes. Many of them, including dyslipidemia, have been linked to both insulin resistance and endothelial dysfunction. Several lines of evidence have led to the hypothesis that insulin resistance may be a key pathophysiological mechanism leading to endothelial dysfunction and atherosclerosis in patients with diabetes and possibly other illnesses. In both diabetic and nondiabetic populations, the common risk factors for coronary artery disease events are dyslipidemia, insulin resistance, obesity and high blood pressure. A number of strategies are recommended to prevent the potentially deadly consequences of these factors.