Evaluating CMR

Etiology and treatment of the metabolic syndrome and its components according to the IDF

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As demonstrated in the Bruneck study, insulin resistance is a very common feature of the metabolic syndrome and its associated diabetic dyslipidemia (13). Although insulin resistance is closely associated with the metabolic syndrome, fasting glucose (a marker of insulin resistance) is not a mandatory criterion for diagnosing the metabolic syndrome. The proposed cut-off value is 5.6 mmol/l (100 mg/dl) (or previously diagnosed diabetes), as suggested by the American Diabetes Association (14). If fasting glycemia is between 6.1 (110 mg/dl) and 6.9 mmol/l (125 mg/dl), the IDF suggests performing an oral glucose tolerance test to diagnose impaired glucose tolerance or type 2 diabetes (15). The IDF calls on insulin-resistant patients to adopt a healthy lifestyle, highlighting the fact that subjects in the Diabetes Prevention Program and Finnish Diabetes Prevention Study who modified their lifestyle were able to reduce or delay the onset of type 2 diabetes (16, 17).

Regarding the pro-inflammatory and pro-thrombotic profile, the IDF singles out the inflammatory marker C-reactive protein, which is positively associated with insulin resistance and obesity, as a common feature of the metabolic syndrome (18). Components of the pro-thrombotic profile of the metabolic syndrome include fibrinolytic factors such as plasminogen activator inhibitor-1. The IDF also believes that further research is required in this area, as other adipokines resulting from the macrophage infiltration of adipose tissue, such as tumour necrosis factor-α and inteurleukin-6, are thought to significantly influence the insulin resistance tied to intra-abdominal adipose tissue and the related inflammatory state. The mechanisms by which fibrinolytic and clotting factors such as fibrinogen are associated with the metabolic syndrome need further clarification. For more information, please refer to Complications of Intra-abdominal Obesity and Managing CMR sections.

Reference

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13. Bonora E, Kiechl S, Willeit J, et al. Prevalence of insulin resistance in metabolic disorders: the Bruneck Study. Diabetes 1998; 47: 1643-9.

14. Genuth S, Alberti KG, Bennett P, et al. Follow-up report on the diagnosis of diabetes mellitus. Diabetes Care 2003; 26: 3160-7.

15. Alberti KG, Zimmet P and Shaw J. International Diabetes Federation: a consensus on Type 2 diabetes prevention. Diabet Med 2007; 24: 451-63.

16. Knowler WC, Barrett-Connor E, Fowler SE, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002; 346: 393-403.

17. Tuomilehto J, Lindstrom J, Eriksson JG, et al. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med 2001; 344: 1343-50.

18. Lemieux I, Pascot A, Prud'homme D, et al. Elevated C-reactive protein: another component of the atherothrombotic profile of abdominal obesity. Arterioscler Thromb Vasc Biol 2001; 21: 961-7.

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