[What is 'metabolic domino effect'?--new concept in lifestyle-related diseases]

Lifestyle-related diseases such as hypertension, hyperlipidemia, and impaired glucose tolerance are independent risk factors for cardiovascular diseases. When these risk factors accumulate, the risk of cardiovascular diseases remarkably increases. This condition, marked by an accumulation of these risk factors in one person, is considered a disease entity by itself called the 'metabolic syndrome'. The effects of this syndrome over time are now being referred to as 'metabolic domino effect'. This new concept considers factors such as the flow of time and the chain reaction of the risk factors. When these risk factors accumulate in one person over time, the risk factors interact and multiply the cardiovascular risk, leading to a process similar to falling dominoes; once the process begins, it leads to cardiovascular diseases that are irreversible. Data strongly suggests that angiotensin II is a contributing factor at every step of the process in this metabolic domino effect, starting from obesity to the progression of macroangiopathy and microangiopathy. The key to effectively preventing cardiovascular diseases is to suppress production of angiotensin II at an early stage of the metabolic syndrome.