Evaluating CMR

AACE

These modifications include recognition of the limitations of fasting glucose values and recognition of the merits of the oral glucose tolerance test. In describing syndrome etiology, the Task Force remarked that obesity should not be seen as a consequence of insulin resistance, but more akin to a physiological factor affecting insulin sensitivity. Obesity should therefore be considered a causal risk factor of the insulin resistance syndrome. The Task Force also recommended adding BMI as a measure of obesity. It felt that waist circumference did not provide sufficient additional information on overall risk, though it does view abdominal obesity as a prevalent form of insulin resistance. The Task Force also called for obesity cut-offs to be adjusted for ethnicity and ethnicity per se to be considered a risk factor. Moreover, the Task Force suggested expanding the list of at-risk individuals and the list of associated disorders, such as familial history of type 2 diabetes, hypertension, CVD, personal history of CVD, polycystic ovary syndrome, gestational diabetes, and acanthosis nigricans. The AACE report also noted that physical inactivity is closely tied to insulin resistance and recommended early and more aggressive lifestyle interventions aimed at improving fitness and nutritional status to prevent the harmful effects of the insulin resistance syndrome. In addition, the report identified pharmacotherapy as an important option although very few pharmacological compounds have been proven to prevent, delay, or treat insulin resistance syndrome. Given this, thiazolidinedione compounds should benefit from further research to establish their clinical utility in targeting the insulin resistance syndrome. Special focus should be placed on their cardiovascular safety.