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Multiple CHD risk factors in type 2 diabetes: beyond hyperglycaemia.
1Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA. greaven@cumed.stanford.edu
Diabetes, Obesity & Metabolism
|February 15, 2002
Summary
Achieving good glycaemic control is challenging and does not fully prevent coronary heart disease (CHD) in type 2 diabetes. Syndrome X, characterized by insulin resistance and associated metabolic abnormalities, accelerates atherosclerosis and increases cardiovascular risk.
Area of Science:
- Cardiology
- Endocrinology
- Metabolic Syndrome
Background:
- Good glycaemic control in type 2 diabetes mellitus (T2DM) improves microvascular outcomes but does not sufficiently reduce coronary heart disease (CHD) risk.
- Syndrome X, a cluster of insulin resistance-related abnormalities, is implicated in accelerating atherosclerosis and increasing cardiovascular risk in T2DM patients.
Purpose of the Study:
- To explore the role of Syndrome X in accelerating atherogenesis and cardiovascular risk in patients with type 2 diabetes.
- To highlight the complex interplay of metabolic abnormalities contributing to CHD in the context of insulin resistance.
Main Methods:
- Review of recent evidence, including the United Kingdom Prospective Diabetes Study.
- Analysis of the components of Syndrome X and their contribution to atherosclerosis.
- Examination of the impact of insulin resistance and hyperinsulinaemia on endothelial function and prothrombotic state.
Main Results:
- Syndrome X encompasses hypertension, hyperinsulinaemia, dyslipidaemia (small, dense LDL-C, high triglycerides, low HDL-C), and a procoagulant state.
- This dyslipidaemia and hyperinsulinaemia promote a prothrombotic state via plasminogen activator inhibitor-1.
- Insulin resistance accelerates plaque formation through increased endothelial adhesion molecules and monocyte adhesion.
Conclusions:
- Syndrome X and type 2 diabetes present multiple abnormalities that enhance the atherosclerotic process.
- Understanding the complex factors of insulin resistance, hyperinsulinaemia, and their link to CHD is crucial for developing new therapeutic strategies to reduce cardiovascular risk.