Fibrates

Raising HDL and triglyceride lowering with the use of fenofibrate has also been demonstrated to affect clinical events, although to a lesser extent than LDL lowering. The Veterans Affairs High-density lipoprotein cholesterol Intervention Trial (VAHIT) of 2531 patients found that gemfibrozil was associated with a 20 reduction in the risk of death or MI27. The Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) trial randomized almost 10 000 diabetics who were not taking a statin to...

Smoking

Smoking remains one of the most potent modifiable risk factors for cardiovascular disease. Despite numerous studies documenting the cardiovascular sequelae of smoking and multiple public education campaigns, a significant subset of the US population continues to smoke. Smokers not only place themselves at risk for cardiovascular events, but also those around them as increasing data suggest that second-hand smoke is an underestimated and under-recognized risk factor. Smoking is a significant and...

Low Highdensity Lipoprotein Levels

While much of the current focus of therapy for dys-lipidemia centers on management of high LDL cholesterol, low HDL cholesterol levels have also been established as a major cardiovascular risk factor. In fact, the pattern of low HDL cholesterol levels with normal LDL cholesterol levels appears to represent a significant percentage of patients with coronary artery disease when compared with isolated high LDL cho-lesterol32. Low HDL cholesterol levels are also an important part of the criteria...

High Lowdensity Lipoprotein Levels

High LDL cholesterol levels have gained increasing importance over the past several years not only as a major cardiovascular risk factor, but also as a crucial target in primary and secondary prevention. The NCEP ATP III classifies LDL cholesterol levels of less than 100 mg dL as optimal, 100-129 mg dL as near or above optimal, 130-159 mg dL as borderline high, 160-189 mg dL as high, and greater than or equal to 190 mg dL as very high (Table 7.4)33. These classifications reflect the observation...

Inflammation And Cardiovascular Risk

Inflammation is an intrinsic part of the pathogenesis of atherosclerosis and cardiovascular disease (CVD)1. Accumulation of inflammatory cells in the vessel wall and predominantly in so-called vulnerable plaques suggests that the most vulnerable sites in the vessel wall have the most intense inflammatory activity2'3. Inflammatory cells whether in the vessel wall or the circulation produce a number of inflammatory proteins called cytokines which are central to the proinflammatory response of the...

Impaired Glucose Tolerance Impaired Fasting Glucose Insulin Resistance And Diabetes

Impaired glucose tolerance, impaired fasting glucose, insulin resistance, and diabetes mellitus represent a spectrum of disorders that is associated with an elevated risk of cardiovascular complications. Impaired glucose tolerance, impaired fasting glucose, and insulin resistance are also risk factors for the development of overt diabetes. Importantly, the NCEP ATP III considers diabetes to be a coronary heart disease risk equivalent, conferring the same risk for coronary events as would be...

Hypertension

Hypertension continues to be one of the most prevalent and treatable components of the cardiometabolic syndrome. A recent review of the National Health and Nutrition Examination Survey (NHANES) suggests that an estimated 58.4 million Americans have high blood pressure requiring therapy1. Worldwide, the prevalence of hypertension has been estimated to be as high as 1 billion people with 7.1 million deaths per year related to its complications2. In the US, hypertension continues to be...

Liporegulation

Indirect Calorimetry

Fat metabolism and carbohydrate metabolism are inherently related. Lipid abnormalities have been shown to have profound effects on carbohydrate metabolism as exemplified by the 'lipotoxicity' hypothesis. This hypothesis suggests that the abnormal accumulation of lipids, e.g. triglycerides and fatty acyl-CoA in muscle and liver, results in insulin resistance15,16. Several lines of evidence support this observation such Figure 4.2 Health care professionals typically assess metabolic measurements...

Endothelial dysfunction

The vascular endothelium has received considerable research attention based on its primary role in modulating the underlying blood vessel tone by producing a number of factors. These factors include vasoconstrictors, vasodilators, in addition to agents involved in inflammatory and fibrinolytic pathways (Table 2.2). Agents that preferentially dilate the vascular wall include nitric oxide (NO), prostacyclin, brady-kinin, and endothelium-derived hyperpolarization factor. Agents that have been...

B

Wall Lumen Ratio

Figure 7.4 Impact of high-normal blood pressure on the cumulative incidence of cardiovascular disease among women (a) and men (b). Optimal blood pressure is defined as a systolic blood pressure of < 120mmHg and diastolic blood pressure of < 80 mmHg. Normal blood pressure is defined as a systolic blood pressure of 120-129 mmHg or a diastolic blood pressure of 80-84 mmHg. High-normal blood pressure is defined as a systolic blood pressure of 130-139 mmHg and a diastolic blood pressure of 85-89...

Measurement Of Insulin Resistance And Clinical Assessment

Glucose Clamp Techniques

Clinically, a number of techniques have been developed to detect the presence of insulin resistance and assessments vary in complexity and precision (Figure 2.2)2-6. However, from a clinical perspective, the most practical way of assessing insulin resistance is the measurement of plasma insulin levels. (Insulin is produced in pancreatic p-cells and is released into the bloodstream in response to stimulation that occurs after a meal ingestion (Figures 2.3 and 2.4)7. As type 2 diabetes is...

Diabetes hypertension

Figure 6.20 Schematic of the postulated multiple mechanisms by which microalbuminuria may be associated with cardiovascular risk Figure 6.20 Schematic of the postulated multiple mechanisms by which microalbuminuria may be associated with cardiovascular risk Figure 6.21 Data showing risk of death among subjects with and without microalbuminuria. From reference 32, with permission Figure 6.21 Data showing risk of death among subjects with and without microalbuminuria. From reference 32, with...

Atherogenic Dyslipidemia

Insulin Cholesterol Relationship

Insulin resistant states such as the metabolic syndrome are commonly associated with an atherogenic dyslipidemia that contributes to significantly higher risk of atherosclerosis and cardiovascular disease. Emerging evidence suggests that insulin resistance and its associated metabolic dyslipidemia result from perturbations in key molecules of the insulin signaling pathway, including overexpression of key phos-phatases, and downregulation and or activation of key protein kinase cascades, leading...

Body Fat Distribution

The traditional view of adipose tissue is simply a reservoir for desposition of excess calories only has not been valid for years. It is very true that adipocytes serve as a major tissue for energy storage and there is complications associated with obesity. From reference 1, with permission Gallstones, pancreatitis, abdominal hernia, NAFLD* (steatosis, steatohepatitis, and cirrhosis), and possibly GERDf Metabolic syndrome, insulin resistance, impaired glucose tolerance, type 2 diabetes...