Skip to main content

Advertisement

SpringerLink
Log in

Lipid abnormalities in the metabolic syndrome

  • Published:
Current Diabetes Reports Aims and scope Submit manuscript

Abstract

The metabolic syndrome is the constellation of adverse metabolic and clinical effects of insulin resistance. Its high and increasing prevalence and its profound impact on the major diseases of the western world require that clinicians consider its diagnosis and management on a routine basis. Recently published guidelines on its definition now make convenient and reliable diagnosis possible. Also, there is new and better understanding of the complex dyslipidemias and other risk factors strongly associated with the metabolic syndrome, which greatly increase the risk of clinical atherosclerotic events. Comprehensive clinical evaluation of these dyslipidemias and associated atherosclerosis risk factors can lead to their aggressive treatment, customized according to the circumstances of each patient. These steps are now more feasible and more clearly desirable than ever before. Statins alone greatly reduce atherosclerosis risk, but combination lipid therapy is often required for optimal dyslipidemia management and atheroprevention.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. Diabetes Prevention Program Research Group [no authors listed]. N Engl J Med 2002, 346:393–403. Dramatic reduction of diabetes incidence in impaired glucose tolerance with metformin, whereas diet and exercise were even more effective.

    Article  Google Scholar 

  2. Ford E, Giles W, Dietz WH, et al.: Prevalence of the metabolic syndrome among US adults. JAMA 2002, 287:356–359. First study to apply the NCEP ATP III guidelines for the metabolic syndrome (insulin resistance) in a large population, showing very high prevalence of nearly one-quarter among US adults.

    Article  PubMed  Google Scholar 

  3. Kannel WB, McGee DL: Diabetes and cardiovascular disease. The Framingham Study. JAMA 1979, 241:2035–2038.

    Article  PubMed  CAS  Google Scholar 

  4. Keen H, Rose G, Pyke DA, et al.: Blood-sugar and arterial disease. Lancet 1965, 2:505–508.

    Article  PubMed  CAS  Google Scholar 

  5. Isomaa B, Almgren P: Cardiovascular morbidity and mortality associated with the metabolic syndrome. Diabetes Care 2001, 24:683–689.

    Article  PubMed  CAS  Google Scholar 

  6. Alberti KG, Zimmet PZ: Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: Diagnosis and classification of diabetes mellitus, provisional report of a WHO consultation. Diabet Med 1998, 15:539–553.

    Article  PubMed  CAS  Google Scholar 

  7. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) [no authors listed]. JAMA 2001, 285:2486–2497. Current guidelines for lipid management in atheroprevention; new emphasis on diabetes mellitus, insulin resistance, and global risk.

    Article  Google Scholar 

  8. National Diabetes Data Group: Diabetes in America, edn. 2. Bethesda, MD: Nations Institutes of Health; 1995.

    Google Scholar 

  9. Fontbonne AM, Eschwege EM: Insulin and cardiovascular disease. Diabetes Care 1991, 14:461–469.

    Article  PubMed  CAS  Google Scholar 

  10. Kanaya A, Grady D, Barrett-Conner E: Explaining the sex difference in coronary heart disease mortality among patients with type 2 diabetes mellitus. Arch Intern Med 2002, 162:1737–1745.

    Article  PubMed  Google Scholar 

  11. Gu K, Cowie C, Harris M: Diabetes and decline in heart disease mortality in US adults. JAMA 1999, 281:1291–1297.

    Article  PubMed  CAS  Google Scholar 

  12. Haffner SM, Lehto S, Ronnemaa T, et al.: Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. N Engl J Med 1998, 339:229–234.

    Article  PubMed  CAS  Google Scholar 

  13. Lotufo P, Gaziano M, Chae CU, et al.: Diabetes and all-cause and coronary heart disease mortality among US male physicians. Arch Intern Med 2001, 161:242–247.

    Article  PubMed  CAS  Google Scholar 

  14. Caballero AE, Arora S, Saouaf R, et al.: Microvascular and macrovascular reactivity is reduced in subjects at risk for type 2 diabetes. Diabetes 1999, 48:1856–1862.

    Article  PubMed  CAS  Google Scholar 

  15. Feener EP, King GL: Vascular dysfunction in diabetes mellitus. Lancet 1997, 350(suppl 1):S19-S13.

    Google Scholar 

  16. Effects of ramipril on cardiovascular and microvascular outcomes in people with diabetes mellitus: results of the HOPE study and MICRO-HOPE substudy. Heart Outcomes Prevention Evaluation (HOPE) Study Investigators [no authors listed]. The Lancet 2000, 355:253–259.

  17. Effects of angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. The Heart Outcomes Prevention Evaluation Study Investigators [no authors listed]. N Engl J Med 2000, 342:145–153.

  18. Rexrode KM, Carey VJ, Hennekens CH, et al.: Abdominal adiposity and coronary heart disease in women. JAMA 1998, 280:1843–1848.

    Article  PubMed  CAS  Google Scholar 

  19. Festa A, D’Agostino RD Jr, Mykkanen L, et al.: Relative contribution of insulin and its precursors to fibrinogen and PAI-1 in a large population with different states of glucose tolerance. Arterioscler Thromb Vasc Biol 1999, 19:562–568.

    PubMed  CAS  Google Scholar 

  20. Meigs J, Mittleman M, Nathan DM, et al.: Hyperinsulinemia, hyperglycemia, and impaired hemostasis. JAMA 2000, 283:221–228.

    Article  PubMed  CAS  Google Scholar 

  21. Hofmann C, Lorenz K, Braithwaite SS, et al.: Altered gene expression for tumor necrosis factor-alpha and its receptors during drug and dietary modulation of insulin resistance. Endocrinology 1994, 134:264–270.

    Article  PubMed  CAS  Google Scholar 

  22. Rossi E, Biasucci L, Citterio F, et al.: Risk of myocardial infarction and angina in patients with severe peripheral vascular disease. Circulation 2002, 105:800–803.

    Article  PubMed  Google Scholar 

  23. Tan K, Chow W, Tam SC. et al.: Atorvastatin lowers C-reactive protein and improves endothelium-dependent vasodilation in type 2 diabetes mellitus. J Clin Endocrinol Metab 2002, 87:563–568.

    Article  PubMed  CAS  Google Scholar 

  24. Festa A, D’Agostinr RJr, Howard G, et al. Chronic subclinical inflammation as part of the insulin resistance syndrome. The Insulin Resistance Atherosclerosis Study. Circulation 2000, 102:42–47.

    PubMed  CAS  Google Scholar 

  25. Jialal I, Stein D, Balis D, et al.: Effect of hydroxymethyl glutaryl coenzyme A reductase inhibitor therapy on high sensitive C-reactive protein levels. Circulation 2001, 103:1933–1935.

    PubMed  CAS  Google Scholar 

  26. Verma S, Wang C, Li SH, et al.: A self-fulfilling prophecy C-reactive protein attenuates nitric oxide production and inhibits angiogenesis. Circulation 2002, 106:913–919.

    Article  PubMed  CAS  Google Scholar 

  27. Garg A, Grundy SM: Management of dyslipidemia in NIDDM. Diabetes Care 1990, 13:153–169.

    Article  PubMed  CAS  Google Scholar 

  28. Haffner S, D’Agostino R, Mykkanen L, et al.: Insulin sensitivity in subjects with type 2 diabetes. Diabetes Care 1999, 22:562–568.

    Article  PubMed  CAS  Google Scholar 

  29. Tenkanen L, Pietila Manninen V, Manttari M: The triglyceride issue revisited. Arch Intern Med 1994, 154:2714–2720.

    PubMed  CAS  Google Scholar 

  30. Stampfer M, Sacks F, Salvini S, et al.: A prospective study of cholesterol, apolipoproteins, and the risk of myocardial infarction. N Engl J Med 1991, 325:373–381.

    Article  PubMed  CAS  Google Scholar 

  31. Stamler J, Vaccaro O, Neaton JD, Wentworth D: Diabetes, other risk factors, and 12-yr cardiovascular mortality for men screened in the multiple risk factor intervention trial. Diabetes Care 1993, 16:434–444.

    Article  PubMed  CAS  Google Scholar 

  32. Gray RS, Robbins D, Wang W, et al.: Relation of LDL size to insulin resistance syndrome and coronary heart disease in american indians: the Strong Heart Study. Arterioscler Thromb Vasc Biol 1997, 17:2713–2720.

    PubMed  CAS  Google Scholar 

  33. Howard BV, Cowan LD, Go O, et al.: Adverse effects of diabetes on multiple cardiovascular disease risk factors in women. The Strong Heart Study. Diabetes Care 1998, 21:1258–1265.

    Article  PubMed  CAS  Google Scholar 

  34. Lamarche B, Tchernof A, Moorjani S: Small, dense low-density lipoprotein particles as a predictor of the risk of ischemic heart disease in men. prospective results from the Quebec Cardiovascular Study. Circulation 1997, 95:60–75.

    Google Scholar 

  35. Austin M, King MC, Vranizan KM, Krauss RM: Atherogenic lipoprotein phenotype. A proposed genetic marker for coronary heart disease risk. Circulation 1990, 82:495–506.

    PubMed  CAS  Google Scholar 

  36. Management of Dyslipidemia in Adults With Diabetes. American Diabetes Association [no authors listed]. Diabetes Care 1999, 22:S56–S59.

  37. MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20,536 high-risk individuals: a randomized placebo-controlled trial. Heart Protection Study Collaborative Group [no authors listed]. Lancet 2002, 360:7–22. Largest and most provocative event-based statin trial. Benefit seen in all subjects regardless of baseline LDL-C, but events were still proportional to on-treatment LDL-C.

    Article  Google Scholar 

  38. Downs J, Clearfield D, Weis S, et al.: Primary prevention of acute coronary events with lovastatin in men and women with average cholesterol levels. JAMA 1998, 279:1615–1622.

    Article  PubMed  CAS  Google Scholar 

  39. Goldberg RB, Mellies MJ, Sacks FM, et al.: Cardiovascular events and their reduction with pravastatin in diabetic and glucose-intolerant myocardial infarction survivors with average cholesterol levels: subgroup analyses in the cholesterol and recurrent events (CARE) trial. The Care Investigators. Circulation 1998, 98:2513–2519.

    PubMed  CAS  Google Scholar 

  40. Randomised trial of cholesterol lowering 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S) [no authors listed]. Lancet 1994, 344:1383–1389.

  41. Prevention of cardiovascular events and death with pravastatin in patients with coronary artery disease and a broad range of initial cholesterol levels. The Long-Term Intervention with Pravastatin in Ischaemic Disease (LIPID) Study Group [no authors listed]. N Engl J Med 1998, 339:1349–1357.

  42. Pyorala K, Pedersen T, Kjekshus J, et al.: Cholesterol lowering with simvastatin improves prognosis of diabetic patients with coronary heart disease. Diabetes Care 1997, 20:614–620.

    Article  PubMed  CAS  Google Scholar 

  43. Haffner SM, Alexander CM, Cook TJ, et al.: Reduced coronary events in simvastatin-treated patients with coronary heart disease and diabetes or impaired fasting glucose levels: subgroup analyses in the Scandinavian Simvastatin Survival Study. Arch Intern Med 1999, 159:2627–2628.

    Article  Google Scholar 

  44. Athyros V, Papageorgiou A, et al.: Treatment with atorvastatin to the national cholesterol educational program goal versus "usual" care in secondary coronary heart disease prevention. Curr Med Res Opin 2002, 18:220–228. First event-based trial to test the effects of treating to the NCEP ATP III LDL-C goal.

    Article  PubMed  Google Scholar 

  45. Sacks F: The role of high-density lipoprotein (HDL) cholesterol in the prevention and treatment of coronary heart disease: expert group recommendations. Am J Cardiol 2002, 90:139–143. First "consensus" guidelines to recommend a treatment goal for HDL-C.

    Article  PubMed  CAS  Google Scholar 

  46. Elam MB, Hunninghake DB, Davis KB, et al.: Effect of niacin on lipid and lipoprotein levels and glycemic control in patients with diabetes and peripheral arterial disease: the ADMIT study: a randomized trial. JAMA 2000, 284:1263–1270. Good evidence that glucose increases with regular niacin therapy in type 2 diabetes are only mild and temporary.

    Article  PubMed  CAS  Google Scholar 

  47. Grundy S, Vega G, McGovern ME, et al.: Efficacy, safety, and tolerability of once-daily niacin for the treatment of dyslipidemia associated with type 2 diabetes: results of the assessment of diabetes control and evaluation of the efficacy of niaspan trial. Arch Intern Med 2002, 162:1568–1576. Good evidence that glucose increases with extended-release niacin therapy in type 2 diabetes are only mild and temporary.

    Article  PubMed  CAS  Google Scholar 

  48. Koskinen P, Manttari M, Manninen V, et al.: Coronary heart disease incidence in NIDDM patients in the Helsinki Heart Study. Diabetes Care 1992, 15:820–825.

    Article  PubMed  CAS  Google Scholar 

  49. Rubins HB, Robins SJ, Collins D, et al.: Gemfibrozil for the secondary prevention of coronary heart disease in men with low levels of high-density lipoprotein cholesterol. N Engl J Med 1999, 341:410–418.

    Article  PubMed  CAS  Google Scholar 

  50. Effect of fenofibrate on progression of coronary-artery disease in type 2 diabetes: the Diabetes Atherosclerosis Intervention Study, a randomised study. Diabetes Atherosclerosis Study Investigators [no authors listed ]. Lancet 2001, 357:905–910.

  51. Ballantyne CM, Olsson AG, Cook TJ, et al.: Influence of low HDL-C and elevated triglyceride on CHD events and response to simvastatin in 4S. Circulation 2001, 104:3046–3051.

    PubMed  CAS  Google Scholar 

  52. Frick M, Elo O, Haapa K, et al.: Helsinki Heart Study: primary-prevention trial with gemfibrozil in middle-aged men with dyslipidemia. N Engl J Med 1987, 317:1237–1245.

    Article  PubMed  CAS  Google Scholar 

  53. Koskinen P, Mantarri M, Manin V, et al.: Coronary heart disease incidence in NIDDM patients in the Helsinki Heart Study. Diabetes Care 1992, 15:820–825.

    Article  PubMed  CAS  Google Scholar 

  54. Brown BG, Zhao X-Q, Chait A, et al.: Simvastatin and niacin, antioxidant vitamins, or the combination for the prevention of coronary disease. N Engl J Med 2001, 345:1583–1592. Simvastatin and niacin greatly reduce coronary angiographic progression and CHD events; addition of antioxidants antagonizes benefits.

    Article  PubMed  CAS  Google Scholar 

  55. American Diabetes Association. Aspirin therapy in diabetes [no authors listed]. Diabetes Care 2002, 25:S78–S79.

  56. American Diabetes Association. Treatment of hypertension in adults with diabetes [no authors listed]. Diabetes Care 2002, 25:S71–S73.

Download references

Author information

Authors and Affiliations

  1. Department of Internal Medicine, Carl T. Hayden VA Medical Center, Section of Metabolism,Endocrinology, & Nutrition, 650 East Indian School Road, 111 E, 85012, Phoenix, AZ, USA

    Eliot A. Brinton MD

Authors
  1. Eliot A. Brinton MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Brinton, E.A. Lipid abnormalities in the metabolic syndrome. Curr Diab Rep 3, 65–72 (2003). https://doi.org/10.1007/s11892-003-0056-3

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11892-003-0056-3

Keywords

Search

Navigation