Managing Cardiometabolic Risk

Exercise and Cardiometabolic Risk

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In the past 20 years, awareness has increased of the complex relationship between individual metabolic abnormalities and subsequent risk of cardiovascular disease (CVD) and type 2 diabetes. Yet our knowledge of this relationship is not new. In 1923, a common clustering of risk factors including obesity, hypertension, and gout had already been described (1). However, it was not until Reaven’s 1988 Banting lecture (2) that the combination of insulin resistance, dyslipidemia, and hypertension was proposed as a unique entity (syndrome X) that increased CVD and diabetes risk. In addition, based on the early observations of Vague (3, 4), others recognized the key role of fat distribution, excess abdominal fat in particular, as a mediator of metabolic risk and component of the syndrome (5). Over the years, the cluster of obesity (particularly abdominal obesity), insulin resistance, hypertension, and dyslipidemia has been given a variety of names, including syndrome X (2), the deadly quartet (5), dysmetabolic syndrome (6), insulin resistance syndrome (7), and more. Major organizations such as the World Health Organization (WHO) (8) and others (9-11) have recently adopted the term “metabolic syndrome” for clinical diagnostic purposes. Although metabolic syndrome clinical criteria and cut-off values vary between organizations, they often include the following: 1) elevated waist circumference, waist-to-hip ratio, or body mass index, 2) elevated triglycerides, 3) low HDL cholesterol levels, 4) elevated blood pressure, and 5) impaired fasting glucose or glucose intolerance (8-11).

Reference

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1. Kylin E. Studien ueber das hypertonie-hyperglykämie-hyperurikämiesyndrom. Zentralblatt Fuer Innere Med 1923; 44: 105-27.

2. Reaven GM. Role of insulin resistance in human disease. Diabetes 1988; 37: 1595-607.

3. Vague J. La différenciation sexuelle: facteur déterminant des formes de l'obesité. Presse Med 1947; 339-40.

4. Vague J. The degree of masculine differentiation of obesities: a factor determining predisposition to diabetes, atherosclerosis, gout, and uric calculous disease. Am J Clin Nutr 1956; 4: 20-34.

5. Kaplan NM. The deadly quartet. Upper-body obesity, glucose intolerance, hypertriglyceridemia, and hypertension. Arch Intern Med 1989; 149: 1514-20.

6. Groop L and Orho-Melander M. The dysmetabolic syndrome. J Intern Med 2001; 250: 105-20.

7. Haffner SM, Valdez RA, Hazuda HP, et al. Prospective analysis of the insulin-resistance syndrome (syndrome X). Diabetes 1992; 41: 715-22.

8. Definition, Diagnosis and Classification of Diabetes Mellitus and its Complications. Report of a WHO Consultation. Geneva: World Health Organization. 1999.

9. Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA 2001; 285: 2486-97.

10. Grundy SM, Brewer HB, Jr., Cleeman JI, et al. Definition of metabolic syndrome: Report of the National Heart, Lung, and Blood Institute/American Heart Association conference on scientific issues related to definition. Circulation 2004; 109: 433-8.

11. Alberti KG, Zimmet P and Shaw J. The metabolic syndrome--a new worldwide definition. Lancet 2005; 366: 1059-62.

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