Volume 73 Number 5 September 2006	back to contents

From the Division of Endocrinology, Diabetes and Metabolic Diseases, Department of Medicine, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA.

Address all correspondence to Barry J. Goldstein, M.D., Ph.D., Director, Division of Endocrinology, Diabetes and Metabolic Diseases, Department of Medicine, Jefferson Medical College, Jefferson Alumni Hall, Suite 349, 1020 Locust Street, Philadelphia, PA 19107-6799; e-mail: barry.goldstein@jefferson.edu

Adapted from a Grand Rounds presentation to the Department of Medicine, Mount Sinai School of Medicine, New York, NY on February 7, 2005, and updated as of October 2005.

Abstract

The clinical importance of the metabolic syndrome is that this group of risk factors greatly increases the likelihood of cardiovascular events, the major source of disease morbidity and mortality in patients with obesity and type 2 diabetes. Recent studies have helped clarify the mechanisms underlying the vascular dysfunction that leads to cardiovascular outcomes in diabetes. This vascular dysfunction is correlated with visceral adiposity, insulin resistance and alterations in the levels of a variety of circulating factors. The vascular effects of overt hyperglycemia also play an important role in diabetes mellitus. Appropriate management of diabetes in the context of the metabolic syndrome requires that we pay close attention to minimizing cardiovascular risk. In this brief review, we will cover several key concepts in the pathophysiology of type 2 diabetes that confer increased cardiovascular risk and influence the choice of oral therapies for this widespread disorder.

Key Words

Atherosclerosis, myocardial infarction, insulin resistance, obesity, metabolic syndrome, thiazolidinediones, metformin, sulfonylureas.

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