Hostility, the metabolic syndrome, and incident coronary heart disease

This invesgation examined the impact of hostility and the metabolic syndrome on coronary heart disease (CHD) using prospective data from the Normative Aging Study. Seven hundred seventy-four older, unmedicated men free of cardiovascular disease were included in the study. The total Cook-Medley Hostility (Ho) Scale score, anthropometric data, serum lipids, fasting insulin concentrations, blood pressure, cigarette smoking, alcohol consumption, and total dietary calories were used to predict incident CHD during a 3-year follow-up interval. Multivariate analysis indicated that only Ho positively predicted and high-density lipoprotein cholesterol level negatively predicted incident CHD. Ho's effects on CHD may be mediated though mechanisms other than factors that constitute the metabolic syndrome.

Insulin resistance: a metabolic link between depressive disorder and atherosclerotic vascular diseases

The association of depression with insulin resistance (IR) and athersclerotic vascular diseases has been well documented. This review examines the relevance of IR as a link between depressive disorder and atherosclerotic vascular diseases. Relevant articles collected from Medline database over the period of 1966-2001 were reviewed. Studies have shown that IR is a state-dependent abnormality in depression and depression increases the risk of vascular morbidity and mortality. Given that IR is a central component of cardiovascular risk factors, depression-related IR might play a role in the development and progression of coronary and cerebral atherosclerosis in chronic-resistant depression. Further, IR may contribute to the pathophysiology of depressive disorder. In conclusion IR could account for the linkage between depression and atherosclerotic vascular diseases. More studies are needed to examine the importance of improving insulin sensitivity in the treatment of chronic-resistant depression and prevention of depression-related vascular morbidity and mortality.

Prostate cancer: another aspect of the insulin-resistance syndrome?

Insulin resistance and compensatory hyperinsulinaemia are thought to be the underlying factors in the metabolic or insulin-resistance syndrome and can be controlled by diet and exercise. Hyperinsulinaemia has been shown to have a direct effect on the live, suppressing the production of sex hormone-binding globulin (SHBG) and insulin-like growth factor-binding proteins 1 and 2 (IGFBP-1, -2) while stimulating the production of insulin-like growth factor 1 (IGF-1). These factors have been proposed to be important modulators of hormone-related cancers, such as prostate cancer. Men adopting a low-fat diet and daily exercise reduced their levels of serum insulin and IGF-1, while increasing their levels of IGFBP-1 and sex hormone-binding globulin (SHBG). Cell-culture studies with LNCaP prostate cancer cells showed apoptosis of tumour cells and a reduction in serum-stimulated cell growth in the post diet and exercise serum. These results suggest that prostate cancer may be another aspect of the insulin-resistance syndrome and that adopting a low-fat diet combined with regular exercise may reduce the risk for prostate and other hormone-related cancers. This needs to be tested with prospective studies.

Addressing the insulin resistance syndrome: a role for the thiazolidinediones

The global epidemic of type 2 diabetes and cardiovascular disease (CVD) is mirrored by increasing prevalence of the Insulin Resistance Syndrome (IRS) or Metabolic Syndrome. Accumulating data indicate that insulin resistance is the common denominator underlying this cluster of related CVD risk factors. Therapeutic interventions that address insulin resistance and other components of the IRS may be of benefit in reducing the significant health and socioeconomic burden presented by diabetes and CVD. Evidence is discussed that the thiazolidinediones, which improve glycemic control by directly targeting insulin resistance, have the additional benefit of improving many of the CVD risk factors in the IRS, and thus have the potential to reduce CVD in patients with type 2 diabetes.

Obesity and cardiovascular disease

Obesity is a major contributor to the prevalence of cardiovascular disease in the developed world, and yet has only recently been afforded the same level of attention as other risk factors of coronary artery disease. Obesity is a chronic metabolic disorder associated with cardiovascular disease and increased morbidity and mortality. It is apparent that a variety of adaptations/alterations in cardiac structure and function occur as excessive adipose tissue accumulates, even in the absence of comorbidities. Shifts toward a less physically demanding lifestyle are observed today throughout different populations, and this scourge associated with obesity implicates a corresponding increase in the number of individuals afflicted with the metabolic syndrome, which defines the obese patient as being "at risk." Adipose tissue is not simply a passive storehouse for fat, but an endocrine organ that is capable of synthesizing and releasing into the bloodstream a variety of molecules that may impact unfavorably the risk factor profile of a patient. Indeed, obesity may affect atherosclerosis through unrecognized variables and risk factors for coronary artery disease such as dyslipidemia, hypertension, glucose intolerance, inflammatory markers, and the prothrombotic state. By favorably modifying lipids, decreasing blood pressure, and decreasing levels of glycemia, proinflammatory cytokines, and adhesion molecules, weight loss may prevent the progression of atherosclerosis or the occurrence of acute coronary syndrome events in the obese high-risk population.

[Predictive value of insulin-glucose homeostasis markers in patients with metabolic syndrome X]

AIM

To clarify informative value of secretory ability of pancreatic beta-cells and correspondence of insulin values to glycemia in the course of standard glucose tolerance test (GTT) in detection of insulin-resistance in patients with arterial hypertension (AH) to verify metabolic syndrome (MS).

MATERIAL AND METHODS

Correlation and factor analyses were performed of correlations between glycemia, immunoreactive insulin (IRI), C-peptide, glucose/IRI in the course of GTT in 111 AH patients divided into groups by the sum of metabolic disturbances.

RESULTS

The greatest number of correlations were seen for glucose/IRI fasting index. According to the factor analysis, changed sensitivity to insulin and hyperinsulinemia are the first stage of metabolic disturbances in AH irrespective of body mass. In obesity the number of the above correlations is maximal. Multivariance analysis has shown significant differences between AH patients and healthy subjects irrespective of body mass and glucose tolerance.

CONCLUSION

Basal index glucose/IRI < 6 relative units is informative in all the studied variants of metabolic syndrome as regards insulin resistance.

Current concepts in insulin resistance, type 2 diabetes mellitus, and the metabolic syndrome

A clustering of risk factors, including elevated triglycerides, decreased high-density lipoprotein cholesterol, hyperinsulinemia, and hypertension often are observed in patients who are insulin resistant. Insulin resistance has been found to play a critical role in the development of cardiovascular disease, particularly in patients with type 2 diabetes. Patients with insulin resistance have an increase in small, dense low-density lipoprotein (LDL) cholesterol, which is more atherogenic than large, buoyant LDL cholesterol. In the context of insulin resistance, insulin has reduced effects on the phosphatidylinositol 3 kinase (PI3K) pathway, whereas mitogen-activated protein kinase activity is maintained. The result is an exaggeration of the mitogenic actions of insulin leading to vascular smooth muscle proliferation and elevated plasminogen activator inhibitor (PAI)-1. Notably, nitric oxide-mediated vasodilation also is impaired, further contributing to atherogenicity. In addition, hyperinsulinemia further contributes to cardiovascular risk by promoting thrombosis. Patients who are insulin resistant have decreased fibrinolysis, as indicated by increased levels of PAI-1. Studies have shown that enhancing insulin sensitivity with insulin sensitizers, such as thiazolidinediones, may improve insulin resistance and limit the development of adverse cardiovascular consequences.

Interrelationship between serum lipid profile, serum hormones and other components of the metabolic syndrome

The aim of the present study was to investigate the association between the serum lipid profile and components of the metabolic syndrome, such as central obesity (anthropometric, computed tomography and fat cell data), insulin, sex-hormone-binding-globulin (SHBG) and different hormones influencing this important syndrome, e.g. sex steroids, leptin and tumor necrosis factor-alpha (TNF-alpha). The sample consisted of 85 obese patients (30 men and 55 women) who had undergone abdominal surgery. Fasting serum lipids were analysed, as well as anthropometric and computed tomography data, perivisceral and subcutaneous fat cell size and serum glucose and hormones. Abdominal fat revealed itself as an important correlator of the adverse changes in plasma lipoprotein levels, the waist-to-hip-ratio and waist-to-thigh-ratio being the best morphological correlators in men and women, respectively. Intra-abdominal fat (VA) correlated significantly and positively to perivisceral fat cell size in women, while no correlation was found between subcutaneous fat accumulation (SA) and adipocyte size in both genders. Perivisceral fat cell size showed the greatest number of correlations with the adverse plasma lipid profile compared to that in the subcutaneous depot. SHBG and sex steroids showed a negative correlation with serum lipids considered a cardiovascular risk. In contrast, TNF-alpha and C-peptide were inversely correlated with potential protector lipids. In conclusion, abdominal obesity, adipocyte hypertrophy from visceral fat, serum TNF-alpha and C-peptide seem to be the best correlators of the lipoprotein disturbance characteristic of the metabolic syndrome, whereas SHBG and sex steroids could play a protective role regarding the lipid profile associated to this syndrome.

Body fat and cardiovascular risk factors in Indian men in three geographical locations

We studied cardiovascular risk factors in 149 rural, 142 slum dwellers, and 150 urban middle class Indian men (30 to 50 years, mean 40 years) in relation to their body fat. Mean body mass index (BMI) was 21.0, 22.3, and 24.3 kg/m2 and mean body fat percent (bioimpedance) was 20.4, 22.5, and 30.4, respectively. A 75 g oral glucose tolerance test showed no diabetes in rural subjects; 4% of urban slum dwellers and 10% of urban middle class men were diabetic. Hypertension (blood pressure > or = 140/90 mm Hg) was present in 2% of the rural, 4% of the urban slum, and 10% of the urban middle class men. All cardiovascular risk factors were strongly related the percentage of body fat and waist to hip ratio. Two hour plasma glucose concentration and blood pressure were, in addition, independently related to geographical location (urban middle class were higher than slums who were higher than rural men). Our results suggest that urbanization increases the risk of hyperglycemia and hypertension independent of the percentage of body fat or its central distribution.

Total sialic acid and associated elements of the metabolic syndrome in women with and without previous gestational diabetes

OBJECTIVE

Inflammatory markers predict type 2 diabetes and relate to the metabolic syndrome. Gestational diabetes mellitus (GDM) predicts type 2 diabetes and may be part of this syndrome. To examine the association of inflammatory markers with GDM, we investigated total sialic acid (TSA) in women with and without previous GDM.

RESEARCH DESIGN AND METHODS

All women with GDM and a random sample of women from one center of the Brazilian Study of Gestational Diabetes were invited to return 7 years after their index pregnancy. After an interview, an oral glucose tolerance test and anthropometry were performed. A total of 46 women with and 50 women without previous GDM completed the protocol.

RESULTS

Mean TSA was significantly higher in women with (71.8 +/- 11.1 mg/dl) than without (67.5 +/- 9.8 mg/dl) previous GDM (P < 0.05). In a linear regression model, TSA was 4 mg/dl (P < 0.05) higher in women with previous GDM, after adjustment for BMI, fasting insulin sensitivity, and number of years spent in school. In a similar model, current 2-h plasma glucose levels were associated with higher TSA levels after adjustment for waist-to-hip ratio and the log of triglycerides. TSA was strongly correlated with individual components and aggregates (r = 0.55, P < 0.001) of the metabolic syndrome.

CONCLUSIONS

Increased TSA levels are associated with previous GDM and are strongly linked to the metabolic syndrome. These findings in young women suggest that a chronic mild systemic inflammatory response is an early feature of the metabolic syndrome and that GDM may be a window for its investigation.

Epidemiological study on obesity and its comorbidities in urban Chinese older than 20 years of age in Shanghai, China

The aim of this work was to establish the prevalence of overweight and obesity and its associated comorbidities in a Chinese population older than 20 years of age. A group of 2776 randomly selected adults (20-94 years of age) living in the Huayang Community in Shanghai, China, were investigated between 1998 and 2000. Body weight, height, waist and hip circumferences and blood pressure were measured, as were fasting blood glucose, fasting insulin and lipid profile, as well as blood glucose 2 h after a glucose load, and a 75-g glucose tolerance test was performed. The prevalence of overweight was 29.5% and obesity was 4.3%, with a greater number of women being obese than men. More than one-third of the population had abnormal lipid levels. Impaired glucose regulation (IGR) occurred in 10.8%; and 9.8% of the population were classified as having type 2 diabetes mellitus. Hypertension was present in 58.4% of this population. About 21% and 29.3% of the population suffered from high total cholesterol and high triglyceride, respectively. The prevalence of metabolic syndrome was 10.2%. The prevalence of diabetes, IGR and metabolic syndrome increased progressively in association with a body mass index (BMI) of >23 kg m(-2). Hence, although the prevalence of obesity is low in this Chinese population, higher BMI and waist circumference values are clearly associated with an increasing prevalence of comorbidities. The absolute risk of having diabetes, IGR and metabolic syndrome is high in adults with a BMI of > or =23 kg m(-2).

[Hypertension and metabolic syndrome in population of one company. Monotherapy with amlodipine and doxazosin]

In Poland diagnosing of hypertension (HA) and the efficacy of treatment of this condition is still insufficient. Consideration of the concomitant metabolic disorders may help to choose the best line of therapy.

AIM OF THE STUDY

To determine the incidence of HA and concomitant lipid and carbohydrate metabolism disturbances in population of one company. To assess the efficacy of monotherapy of HA and the influence of therapy on some metabolic parameters.

METHODS

The blood pressure was measured in 599 subjects. Patients with HA (> or = 140/90 mmHg) were treated according to metabolic parameters. Patients with fasting total cholesterol (TC) > or = 200 mg% and/or fasting glucose level > or = 110 mg% received doxazosin (D); initial dose 1 mg. The remaining patients received amlodipine (A); initial dose 5 mg.

RESULTS

HA was found in 154 patients (27.5%). In this group, 50 of subjects were unaware of the disease, the remaining 67 (44%) were not treated or treated insufficiently. Elevated glucose and/or TC levels were found in 51% of hypertensives. After one month of treatment with A or D, the mean systolic and diastolic blood pressure decreased significantly (p = 0.001). Monotherapy was effective in 88.9% of subjects in group D and in 92.1% in group A. In group D, TC concentration decreased by 9.5% comparing to baseline (p = 0.001). The tolerance of treatment was similar in both groups.

CONCLUSIONS

One fourth of the examined company population under medical attention of the local health service had HA. One third of HA patients were unaware of the disease. The half of patients with HA had metabolic disorders. Doxazosin and amlodipine were equally effective and well tolerated during one month of treatment. Treatment with doxazosin positively influenced the metabolic profile.

The metabolic syndrome, insulin resistance and cardiovascular disease

In westernised societies the metabolic syndrome (MS) is common and primarily a lifestyle disease with significant morbidity and premature mortality. The main endpoints are related to cardiovascular disease (CVD), especially affecting the heart. Although insulin resistance (and hyperinsulinaemia) is an early marker of MS and future adverse cardiovascular outcomes, it is not known if on its own this is sufficient. The issue is further clouded in prospective studies by the development in study subjects of some, or all of the components of MS, each of which is an independent risk factor for CVD! Therefore, in spite of a number of appropriate long-term observational studies, we are unable to tease out the exact contribution of the individual components of MS, which together are unequivocally responsible for this present-day epidemic of CVD.

Genetic determinants of diabetes and atherosclerosis

Common risk factors for type 2 diabetes and cardiovascular disease are suspected because of the higher than expected prevalence of cardiovascular disease in individuals with newly diagnosed type 2 diabetes and in nondiabetic individuals with impaired glucose tolerance. Some of these risk factors may be genetic in origin. The risk of diabetes and cardiovascular disease may be linked through common pathways, including insulin resistance and/or inflammation. In this review, we describe the rationale for proposing these as common mechanisms affecting both diabetes and cardiovascular risk, and we then summarize the available evidence suggesting that common genes within these pathways have pleiotropic effects influencing susceptibility to both diseases.

[Clinical characteristics of fatty livers of 61 patients with the insulin resistance syndrome]

OBJECTIVE

To analyse the clinical characteristics of fatty livers of patients with the insulin resistance syndrome.

METHODS

With echographic histogram, the acoustic intensity (AV) in six different areas of each fatty liver was measured in 61 patients with the insulin resistance syndrome. The relationship between the average value of AV and some clinical or biochemical parameters were analysed.

RESULTS

There were significant differences in AV between the area near the portal venous and the area near the gall bladder, and between males and females as well. AV was positively related to the body mass ratio (BMI), waist circle (W) and hip circle (H); AV was positively related to the waist-hip ratio (WHR) or insulin sensitive index (ISI) in trend; and AV was negatively related to high density lipoprotein cholesterin (HDL-C).

CONCLUSION

In patients with the insulin resistance syndrome, fatty density of livers is higher near the portal venous than near the gall bladder. The fatty liver is more serious in females than in males. BMI, W, H and serum HDL-C levels are useful parameters in evaluating the severity of fatty livers.

Apolipoprotein C-III and E polymorphisms and cardiovascular syndrome, hyperlipidemia, and insulin resistance in renal transplantation

Hyperlipidemia and insulin resistance frequently develop after renal transplantation, contributing to cardiovascular disease. Individual differences in response based upon genetic variations in proteins regulating lipidic and glucose tolerance metabolism could be expected. In the general population, the S2 allelic variant of the apoprotein (apo) C-III gene has been associated with hypertriglyceridemia and an insulin resistant state, whereas the E4 allele of the apo E has been associated with hypercholesterolemia and atherosclerosis. Its influence in renal transplant patients remains to be seen. In order to assess the impact of apo E and C-III major polymorphisms on atherosclerotic vascular disease, lipid profile and impaired glucose tolerance in renal transplant patients, we studied 110 consecutively examined patients undergoing kidney transplantation (age range 24-73 years). Atherosclerotic complications were detected in 25% of patients, with age, male sex and hypercholesterolemia being significant atherosclerotic risk factors. Among the male patients with E4 allele, the odds ratio for coronary disease and global atherosclerosis were 10.2 (95% CI) and 6.4 (95% CI), respectively. There were no significant differences in the frequency of any of the polymorphisms among patients with dyslipidemia and impaired glucose tolerance. As the number of patients in our sample was small, larger studies are needed to verify these issues. While in the studied population C-III polymorphism appears to have little association with the prevalence of atherosclerotic complications, E4 allele should be considered as a genetic marker of coronary artery disease and global atherosclerosis in renal transplant patients.

Cardiovascular risk in rheumatoid arthritis versus osteoarthritis: acute phase response related decreased insulin sensitivity and high-density lipoprotein cholesterol as well as clustering of metabolic syndrome features in rheumatoid arthritis

Rheumatoid arthritis (RA) patients experience a markedly increased frequency of cardiovascular disease. We evaluated cardiovascular risk profiles in 79 RA patients and in 39 age-matched and sex-matched osteoarthritis (OA) patients. Laboratory tests comprised ultrasensitive C-reactive protein (CRP) and fasting lipids. Insulin sensitivity (IS) was determined by the Quantitative Insulin Sensitivity Check Index (QUICKI) in all OA patients and in 39 of the RA patients. Ten RA patients were on glucocorticoids. RA patients exercised more frequently than OA patients (chi2 = 3.9, P < 0.05). Nine RA patients and one OA patient had diabetes (chi2 = 4.5, P < 0.05). The median CRP, the mean QUICKI and the mean high-density lipoprotein (HDL) cholesterol were 9 mg/l (range, 0.5-395 mg/l), 0.344 (95% confidence interval [CI], 0.332-0.355) and 1.40 mmol/l (95% CI, 1.30-1.49 mmol/l) in RA patients, respectively, as compared with 2.7 mg/l (range, 0.3-15.9 mg/l), 0.369 (95% CI, 0.356-0.383) and 1.68 mmol/l (95% CI, 1.50-1.85 mmol/l) in OA patients. Each of these differences was significant (P < 0.05). After controlling for the CRP, the QUICKI was similar in RA and OA patients (P = 0.07), while the differences in HDL cholesterol were attenuated but still significant (P = 0.03). The CRP correlated with IS, while IS was associated with high HDL cholesterol and low triglycerides in RA patients and not in OA patients. A high CRP (>/= 8 mg/l) was associated with hypertension (chi2 = 7.4, P < 0.05) in RA patients. RA glucocorticoid and nonglucocorticoid users did not differ in IS and lipids (P > 0.05). Excess cardiovascular risk in RA patients as compared with OA patients includes the presence of decreased IS and HDL cholesterol in RA patients. The latter is only partially attributable to the acute phase response. The CRP, IS, HDL cholesterol, triglycerides and hypertension are inter-related in RA patients, whereas none of these relationships were found in OA patients.

Reduction and prevention of the cardiovascular sequelae of the insulin resistance syndrome

Insulin resistance and hyperinsulinemia are the critical characteristics of the metabolic syndrome that is associated with abdominal obesity and are the early manifestations of its progression to type 2 diabetes. These metabolic abnormalities are becoming recognized as a major contributor to cardiovascular disease. The experimental studies required to elucidate the underlying mechanisms and to develop effective preventative strategies will require the use of appropriate animal models and these are available. The evidence from such research indicates that a wide range of interventions (including peroxisome proliferator activator receptor agonists, insulin-sensitizing agents, statins, fibrates, angiotensin-converting enzyme inhibitors, estrogen receptor modulators, lipid-based nutriceuticals, and ethanol) can markedly reduce or prevent vasculopathy and ischemic cardiac lesions in animal models. Overall, the results suggest that early damage to the vascular wall, both in function and presenting as atherosclerotic lesions, is secondary to long-term hyperinsulinemia and, especially, to postprandial peaks in plasma insulin levels, and is exacerbated by the accompanying hyperlipidemia. Effective treatment will, of necessity, be preventative and will necessitate diagnostic approaches that can identify asymptomatic individuals at high risk for vascular damage and eventual progression to type 2 diabetes. Therapeutic targets in this population include insulin sensitivity and the associated signal transduction pathways, the peroxisome proliferator activator receptor-alpha and -gamma systems, and the complex pathways leading from acetyl CoA and the citric acid cycle to the synthesis of fatty acid and the storage of triglyceride. These pharmacological approaches offer the prospect of preventing a significant proportion of cardiovascular disease.

Ninety patients with nonalcoholic steatohepatitis: insulin resistance, familial tendency, and severity of disease

OBJECTIVE

Nonalcoholic steatohepatitis (NASH) is a common but poorly understood liver disease. Our aim was to study a large group of patients referred for Hepatology consultation to further characterize this disorder, in particular its demographics and range of severity. We also sought to better understand its etiology and its relationship to the insulin resistance syndrome, known as the metabolic syndrome or syndrome X.

METHODS

Retrospective review of 90 patients seen over a 4-yr period.

RESULTS

Ninety patients aged 14-70 with NASH seen at the Liver Clinics at either the University of Tennessee or the Medical University of South Carolina. Eleven had complications of portal hypertension and seven of these had undergone or were awaiting transplantation. NASH was seen in nine families either in siblings or in subsequent generations. Diabetes or insulin resistance were present in almost all in this cohort of patients with NASH. Diabetes, hyperlipidemia, hypertension, and atherosclerotic disease, the components of syndrome X, were common in this population.

CONCLUSION

NASH affects males and females equally, and presents over a wide age range. Despite its usually benign course, 28% of patients had cirrhosis and almost half of those had complications of portal hypertension, necessitating liver transplantation. Obesity was common in affected patients and cirrhosis was more common in the morbidly obese. Familial clustering was common, with 18% of patients having a similarly affected first degree relative. The clinical features that define syndrome X (diabetes, hypertension, hyperlipidemia, and atherosclerotic disease) are common in affected patients. Studies of glucose tolerance demonstrated unsuspected diabetes in six, and insulin resistance (the hallmark of syndrome X) in 85% of those tested. We hypothesize that NASH is a disorder of genetic etiology and is the hepatic manifestation of syndrome X, the insulin resistance syndrome.

Metabolic abnormalities characteristic of dysmetabolic syndrome predict the development of transplant coronary artery disease: a prospective study

BACKGROUND

This study examines the hypothesis that metabolic abnormalities of dysmetabolic syndrome are risk factors for transplant coronary artery disease (TxCAD).

METHODS AND RESULTS

Sixty-six patients without overt diabetes, 2 to 4 years after surgery, underwent intracoronary ultrasound (ICUS), measurement of plasma glucose and insulin after oral glucose (75 g), and fasting lipid and lipoproteins. TxCAD incidence by angiography or autopsy was prospectively determined during subsequent follow-up (8 years). Coronary artery intimal thickness (IT) and subsequent outcomes were compared in patients stratified as having "high" versus "low" plasma glucose (>8.9 mmol/L) and insulin (>760 pmol/L) 2 hours after glucose challenge; and "abnormal" versus "normal" fasting lipid and lipoprotein concentrations as defined by the National Cholesterol Education

PROGRAM

Patients with high glucose or insulin concentrations had greater IT: 0.38+/-0.05 versus 0.22+/-0.02 mm, P</=0.05, and 0.39+/-0.05 versus 0.20+/-0.02 mm, P</=0.01, respectively. Freedom from TxCAD was 56+/-11% versus 81+/-6% (P<0.01) in patients with high versus low glucose and 57+/-10% versus 82+/-7% (P<0.05) in patients with high versus low insulin. Actuarial survival was 60+/-12% versus 92+/-5% (P<0.005) in patients with high versus low glucose and 72+/-9% versus 88+/-6% (P<0.05) in patients with high versus low insulin. Triglycerides and VLDL were higher and HDL was lower in patients with IT >0.3 mm than with IT </=0.3 mm. TxCAD incidence was higher in patients with high plasma TG and VLDL and low HDL.

CONCLUSIONS

These data suggest that insulin resistance plays a role in TXCAD:

[Characteristics of the therapy of patients with type II diabetes mellitus and metabolic syndrome]

The article focuses on the action of sugar-lowering drugs of different groups (metformin, acarbose, gliquidone, diacamf, food fibre, in patients with type II diabetes mellitus presenting with the metabolic syndrome. All studied medicinal agents compensated the carbohydrate and lipid metabolism, lowered the body mass, delayed the development of atherosclerosis, which facts were found to alleviate the manifestations of the metabolic syndrome.

[Cardiac syndrome X and insulin resistance]

OBJECTIVE

To determine whether there is insulin resistance in patients with syndrome X.

METHODS

By using oral glucose tolerance test (OGTT), plasma glucose and insulin levels, and insulin sensitivity index (ISI) were measured in 11 patients with syndrome X and in 10 sex and age matched normal subjects as controls.

RESULTS

The syndrome X group had a higher fasting insulin level and ISI than the control group (P < 0.05). After oral glucose, plasma insulin level and ISI in patients with syndrome X were significantly higher than the control group (P < 0.01).

CONCLUSION

In patients with syndrome X there are hyperinsulinemia and insulin resistance.