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- December 1, 2008 |
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"Markers of the metabolic syndrome and CHD risk : evidence from the Quebec Cardiovascular Study"Prof. Jean-Pierre Després (biography)
English - 2002-11-23 - 79 minutes
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Summary :
The prevalence of Type 2 diabetes has substantially increased in North America largely due to the fact that obesity has reached epidemic proportions in our society. Although obesity increases the likelihood of developing Type 2 diabetes, hypertension and coronary heart disease (CHD), not every obese patient is characterized by these complications, emphasizing the heterogeneity of obesity. Evidence reviewed in this symposium will support the notion that body fat distribution, especially visceral adipose tissue accumulation, is a critical correlate of a cluster of diabetogenic, atherogenic, prothrombotic and inflammatory metabolic abnormalities. This " dysmetabolic cluster ", referred to as the insulin resistance or metabolic syndrome, is associated with a substantially increased risk of CHD, even in the absence of hyperglycemia or elevated LDL cholesterol concentrations. Thus, the hyperglycemic state of Type 2 diabetic patients only represents the tip of a huge iceberg of metabolic abnormalities largely resulting from the expanded abdominal visceral adipose mass. Since waist circumference has been suggested to be a useful index of abdominal visceral obesity and of related metabolic complications, it is suggested that waist girth should be systematically measured in all patients. Finally, it is proposed that until waist circumference is identified as a therapeutic target, clinicians will not optimally manage cardiovascular disease risk in abdominally obese patients with Type 2 diabetes or the metabolic syndrome.
Bibliographic references :
1- Insulin resistance and abdominal adiposity in young men with documented malnutrition during the first year of life
Boule NG, Tremblay A, Gonzalez-Barranco J, Aguilar-Salinas CA, Lopez-Alvarenga JC, Despres JP, Bouchard C, Gomez-Perez FJ, Castillo-Martinez L, Rios-Torres JM.
Int J Obes Relat Metab Disord 2003 May;27(5):598-604
http://www.nature.com
2- Fasting insulin and apolipoprotein B levels and low-density lipoprotein particle size as risk factors for ischemic heart disease
Lamarche B, Tchernof A, Mauriege P, Cantin B, Dagenais GR, Lupien PJ, Despres JP
JAMA 1998 Jun 24;279(24):1955-61
http://jama.ama-assn.org/cgi/content/full/279/24/1955
3- Hypertriglyceridemic waist: A marker of the atherogenic metabolic triad (hyperinsulinemia; hyperapolipoprotein B; small, dense LDL) in men?
Lemieux I, Pascot A, Couillard C, Lamarche B, Tchernof A, Almeras N, Bergeron J, Gaudet D, Tremblay G, Prud'homme D, Nadeau A, Despres JP.
Circulation 2000 Jul 11;102(2):179-84
http://circ.ahajournals.org/cgi/content/full/102/2/179
4- Risk factors associated with obesity: a metabolic perspective]
[Article in French]
Despres JP, Pascot A, Lemieux I.
Ann Endocrinol (Paris) 2000 Dec;61 Suppl 6:31-38
http://www.e2med.com
5- Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction.
Haffner SM, Lehto S, Ronnemaa T, Pyorala K, Laakso M
N Engl J Med 1998 Jul 23;339(4):229-34
http://content.nejm.org/cgi/content/abstract/339/4/229
6- Global burden of diabetes, 1995-2025: prevalence, numerical estimates, and projections.
King H, Aubert RE, Herman WH
Diabetes Care 1998 Sep;21(9):1414-31
http://care.diabetesjournals.org
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