Advertisement

The cardiovascular dysmetabolic syndrome

  • Timothy C Fagan
    Correspondence
    Requests for reprints should be addressed to Timothy C. Fagan, MD, University Health Care at Ventana Vista, 5620 North Kolb Road, Suite 166, Tucson, Arizona 85750
    Affiliations
    Departments of Medicine and Pharmacology, University of Arizona College of Medicine, Tucson, Arizona, USA
    Search for articles by this author
  • Prakash C Deedwania
    Affiliations
    Cardiology Division, Department of Medicine, University of California, San Francisco, San Francisco, California, USA

    Stanford University Medical Center, Palo Alto, California, USA
    Search for articles by this author
      A clustering of metabolic abnormalities associated with cardiovascular disease has been recognized since at least 1988.
      • Reaven G.M
      Role of insulin resistance in human disease.
      This clustering has been given many names including Syndrome X, The Deadly Quartet, and The Insulin Resistance Syndrome. For various reasons each of these names is unsatisfactory. The Western Working Group believes that cardiovascular dysmetabolic syndrome (CDS) is the name that best describes this group of abnormalities, because it emphasizes the cardiovascular consequences of these abnormalities, recognizes that they are distinguishable abnormalities, and indicates that any given patient may have some or all of the components of the syndrome.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The American Journal of Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Reaven G.M
        Role of insulin resistance in human disease.
        Diabetes. 1988; 37: 1595-1607
        • Sowers J.R
        Diabetes mellitus and cardiovascular disease in women.
        Arch Intern Med. 1998; 158: 617-621
        • Hsueh W.A
        • Law R.E
        Cardiovascular risk continuum.
        Am J Med. 1998; 105: 4S-14S
        • Nabulsi A.A
        • Folsom A.R
        • Heiss G
        • et al.
        Fasting hyperinsulinemia and cardiovascular disease risk factors in nondiabetic adults.
        Metabolism. 1995; 44: 914-922
        • Haffner S.M
        • Miettinen H
        Insulin resistance implications for type II diabetes mellitus and coronary heart disease.
        Am J Med. 1997; 103: 152-162
        • King G.L
        • Brownlee M
        The cellular and molecular mechanisms of diabetic complications.
        Endocrinol Metab Clin North Am. 1996; 25: 255-270
        • Peters A.L
        • Schriger D.L
        The new diagnostic criteria for diabetes.
        Am J Med. 1998; 105: 15S-19S
        • The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus
        Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus.
        Diabetes Care. 1997; 20: 1183-1197
        • Harris M.I
        • Hadden W.C
        • Knowler W.C
        • Bennett P.H
        Prevalence of diabetes and impaired glucose tolerance and plasma glucose levels in U.S. population aged 20–74 yr.
        Diabetes. 1987; 36: 523-534
        • Engelgau M.M
        • Aubert R.E
        • Thompson T.J
        • Herman W.H
        Screening for NIDDM in nonpregnant adults.
        Diabetes. 1995; 18: 1606-1618
      1. Kenny SJ, Aubert RE, Geiss LS. Prevalence and incidence of non-insulin-dependent diabetes. In: Harris MI, ed. Diabetes in America. 2nd ed. Washington, DC: National Institutes of Health; 1995:47–67. National Institute of Diabetes and Digestive and Kidney Diseases NIH publication 95–1468.

        • Harris M.I
        Impaired glucose tolerance in the U.S. population.
        Diabetes Care. 1989; 12: 100-103
        • Henry R.R
        Type 2 diabetes care.
        Am J Med. 1998; 105: 20S-26S
        • Joubert P.H
        • Venter H.L
        • Foukardis G.N
        The effect of miglitol and acarbose after an oral glucose load.
        Br J Clin Pharmacol. 1990; 30: 391-396
        • Stumvoll M
        • Nurjhan N
        • Perriello G
        • et al.
        Metabolic effects of metformin in non-insulin-dependent diabetes mellitus.
        N Engl J Med. 1995; 333: 550-554
        • Phillips P.J
        • Scicchitano R
        • Clarkson A.R
        • et al.
        Metformin associated lactic acidosis.
        Aust N Z J Med. 1978; 8: 281-284
        • Ciaraldi T.P
        • Huber-Knudsen K
        • Hickman M
        • Olefsky J.M
        Regulation of glucose transport in cultured muscle cells by novel hypoglycemic agents.
        Metabolism. 1995; 44: 976-982
        • Fujiwara T
        • Okuno A
        • Yoshioka S
        Suppression of hepatic gluconeogenesis in long-term troglitazone treated diabetic KK and C57BL/KsJ-db/db mice.
        Metabolism. 1995; 44: 486-490
        • Law R.E
        • Meehan W.P
        • Xi X.-P
        • et al.
        Troglitazone inhibits vascular smooth muscle cell growth and intimal hyperplasia.
        J Clin Invest. 1996; 98: 1897-1905
        • Ghazzi M.N
        • Perez J.E
        • Antonucci T.K
        • et al.
        Cardiac and glycemic benefits of troglitazone treatment in NIDDM.
        Diabetes. 1997; 46: 433-439
        • Henry R.R
        Thiazolidinediones.
        Endocrinol Met Clin North Am. 1997; 26: 553-573
        • Suter S.L
        • Nolan J.J
        • Wallace P
        • et al.
        Metabolic effects of new oral hypoglycemic agent CS-045 in NIDDM subjects.
        Diabetes Care. 1992; 15: 193-203
        • Watkins P.B
        • Whitcomb R.W
        Hepatic dysfunction associated with troglitazone.
        N Engl J Med. 1998; 338 (letter): 916-917
        • The CONSENSUS Trial Study Group
        Effects of enalapril on mortality in severe congestive heart failure.
        N Engl J Med. 1987; 316: 1429-1435
        • Cohn J.N
        • Johnson G
        • Ziesche S
        • et al.
        A comparison of enalapril with hydralazine-isosorbide dinitrate in the treatment of chronic congestive heart failure.
        N Engl J Med. 1991; 325: 303-310
        • The SOLVD Investigators
        Effect of enalapril on mortality and the development of heart failure in asymptomatic patients with reduced left ventricular ejection fractions.
        N Engl J Med. 1992; 327: 685-691
        • Pfeffer M.A
        • Braunwald E
        • Moye L.A
        • et al.
        Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction.
        N Engl J Med. 1992; 327: 669-677
        • Lewis E.J
        • Hunsicker L.G
        • Bain R.P
        • et al.
        The effect of angiotensin-converting-enzyme inhibition on diabetic nephropathy.
        N Engl J Med. 1993; 329: 1456-1462
        • Ravid M
        • Ravid D
        ACE inhibitors in elderly patients with hypertension.
        Drugs Aging. 1996; 8: 29-37
        • Maschio G
        • Alberti D
        • Janin G
        • et al.
        Effect of angiotensin- converting-enzyme inhibitor benazepril on the progression of chronic renal insufficiency.
        N Engl J Med. 1996; 334: 939-945
        • Giatras I
        • Lau J
        • Levey A.S
        Effect of angiotensin-converting enzyme inhibitors on the progression of nondiabetic renal disease.
        Ann Intern Med. 1997; 127: 337-345
        • Quyyumi A.A
        Endothelial function in health and disease.
        Am J Med. 1998; 105: 32S-39S
        • Witztum J.L
        The oxidation hypothesis of atherosclerosis.
        Lancet. 1994; 344: 793-795
        • Parmley W.W
        Evolution of angiotensin-converting enzyme inhibition in hypertension, heart failure, and vascular protection.
        Am J Med. 1998; 105: 27S-31S
        • Chobanian A.V
        • Haudenschild C.C
        • Nickerson C
        • Drago R
        Antiatherogenic effect of captopril in the Watanabe heritable hyperlipidemic rabbit.
        Hypertension. 1990; 15: 327-331
        • Finta K.M
        • Fischer M.J
        • Lee L
        • et al.
        Ramipril prevents impaired endothelium-dependent relaxation in arteries from rabbits fed an atherogenic diet.
        Atherosclerosis. 1993; 100: 149-156
        • Mancini G.B.J
        • Henry G.C
        • Macaya C
        • et al.
        Angiotensin- converting enzyme inhibition with quinapril improves endothelial vasomotor dysfunction in patients with coronary artery disease.
        Circulation. 1996; 94: 258-265
        • Mancini G.B.J
        Role of angiotensin-converting enzyme inhibition in reversal of endothelial dysfunction in coronary artery disease.
        Am J Med. 1998; 105: 40S-47S
        • Gordon D.J
        • Probstfield J.L
        • Garrison R.J
        • et al.
        High-density lipoprotein cholesterol and cardiovascular disease.
        Circulation. 1989; 79: 8-15
        • Criqui M.H
        • Golomb B.A
        Epidemiologic aspects of lipid abnormalities.
        Am J Med. 1998; 105: 48S-57S
        • Hokanson J.E
        • Austin M.A
        Plasma triglyceride level is a risk factor for cardiovascular disease independent of high- density lipoprotein cholesterol level.
        J Cardiovasc Risk. 1996; 3: 213-219
        • Krauss R.M
        Triglycerides and atherogenic lipoproteins.
        Am J Med. 1998; 105: 58S-62S
        • Reaven G.M
        Syndrome X.
        J Intern Med. 1994; 236: 13-22
        • Krauss R.M
        Heterogeneity of plasma low-density lipoproteins and atherosclerosis risk.
        Curr Opin Lipidol. 1994; 5: 339-349
        • Kinosian B
        • Glick H
        • Preiss L
        • Puder K.L
        Cholesterol and coronary heart disease.
        J Invest Med. 1995; 43: 443-450
        • White C.W
        Benefit of aggressive lipid-lowering therapy.
        Am J Med. 1998; 105: 63S-68S
        • Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults
        Summary of the second report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel II).
        JAMA. 1993; 269: 3015-3023
        • Sacks F.M
        • Pfeffer M.A
        • Moye L.A
        • et al.
        The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels.
        N Engl J Med. 1996; 335: 1001-1009
        • The Post Coronary Artery Bypass Graft Trial Investigators
        The effect of aggressive lowering of low-density lipoprotein cholesterol levels and low-dose anticoagulation on obstructive changes in saphenous-vein coronary-artery bypass grafts.
        N Engl J Med. 1997; 336: 153-162
      2. Heart and Stroke Facts: 1997 Statistical Supplement. Dallas, TX: American Heart Association; 1997.

        • Shepherd J
        • Cobbe S.M
        • Ford I
        • et al.
        Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia.
        N Engl J Med. 1995; 333: 1301-1307
        • Amsterdam E.A
        • Deedwania P
        A perspective on hyperlipidemia.
        Am J Med. 1998; 105: 69S-74S
        • Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure
        The sixth report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure.
        Arch Intern Med. 1997; 157: 2413-2446
        • Curb J.D
        • Pressel S.L
        • Cutler J.A
        • et al.
        Effect of diuretic- based antihypertensive treatment on cardiovascular disease risk in older diabetic patients with isolated systolic hypertension.
        JAMA. 1996; 276: 1886-1892
        • Goldberg R
        • Sacks F
        • Howard B
        • et al.
        Diabetic response to pravastatin during the CARE Study.
        Circulation. 1996; 94 (Abstr.): I-540
        • Koskinen P
        • Mänttäri M
        • Manninen V
        • et al.
        Coronary heart disease incidence in NIDDM patients in the Helsinki Heart Study.
        Diabetes Care. 1992; 15: 820-825
        • Pyörälä K
        • Olsson A.G
        • Pedersen T.R
        • et al.
        Cholesterol lowering with simvastatin improves prognosis of diabetic patients with coronary heart disease.
        Diabetes Care. 1997; 20: 614-620