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Vol. 11, Suppl. 2, 2002
Issue release date: November 2002
Open Access Gateway
Med Principles Pract 2002;11(suppl 2):31–40
(DOI:10.1159/000066414)

Insulin Resistance, Impaired Postprandial Lipid Metabolism and Abdominal Obesity

A Deadly Triad

Frayn K.N.
Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, UK
email Corresponding Author

Abstract

Objective: To review three ‘emerging risk factors’ for coronary heart disease, the physiological and pathophysiological mechanisms involved, and their inter-relationships. Background: Classical risk factors for coronary heart disease cannot adequately explain the high incidence of this disease. Abdominal obesity and impaired postprandial lipid metabolism have long been recognised as associates of coronary heart disease but only relatively recently has their importance as risk markers been established. Insulin resistance is now often seen as a common theme underlying many factors predisposing to coronary heart disease (CHD). Mechanisms: The mechanisms by which each of these markers relates to coronary heart disease may have common aspects. Specifically, they are all associated with a characteristic dyslipidaemia involving elevation of plasma triacylglycerol concentrations, reduction of high-density lipoprotein cholesterol (HDL-cholesterol) and the presence of small, dense low-density lipoprotein particles that may carry particular risk of atherogenesis. Insulin resistance is also associated with hypertension and impairment of endothelial function, and with a procoagulant state. Treatment: No specific or separate pharmacological treatment of any of these conditions separately has been shown to reduce the risk of CHD although each can be manipulated. Lifestyle modification, with increased physical activity and dietary change, may offer the best hope of primary prevention but to achieve this, interventions at government level rather than advice from individual physicians would probably be required. Conclusions: Abdominal obesity, impaired postprandial lipid metabolism and insulin resistance are all inter-related risk markers for CHD. They seem to reflect lifestyle in the developed and developing worlds and perhaps modification of lifestyle holds the greatest hope for their amelioration in the future.


 goto top of outline Key Words

  • Coronary heart disease
  • Postprandial lipaemia
  • Insulin resistance
  • Dyslipidaemia
  • Abdominal obesity

 goto top of outline Abstract

Objective: To review three ‘emerging risk factors’ for coronary heart disease, the physiological and pathophysiological mechanisms involved, and their inter-relationships. Background: Classical risk factors for coronary heart disease cannot adequately explain the high incidence of this disease. Abdominal obesity and impaired postprandial lipid metabolism have long been recognised as associates of coronary heart disease but only relatively recently has their importance as risk markers been established. Insulin resistance is now often seen as a common theme underlying many factors predisposing to coronary heart disease (CHD). Mechanisms: The mechanisms by which each of these markers relates to coronary heart disease may have common aspects. Specifically, they are all associated with a characteristic dyslipidaemia involving elevation of plasma triacylglycerol concentrations, reduction of high-density lipoprotein cholesterol (HDL-cholesterol) and the presence of small, dense low-density lipoprotein particles that may carry particular risk of atherogenesis. Insulin resistance is also associated with hypertension and impairment of endothelial function, and with a procoagulant state. Treatment: No specific or separate pharmacological treatment of any of these conditions separately has been shown to reduce the risk of CHD although each can be manipulated. Lifestyle modification, with increased physical activity and dietary change, may offer the best hope of primary prevention but to achieve this, interventions at government level rather than advice from individual physicians would probably be required. Conclusions: Abdominal obesity, impaired postprandial lipid metabolism and insulin resistance are all inter-related risk markers for CHD. They seem to reflect lifestyle in the developed and developing worlds and perhaps modification of lifestyle holds the greatest hope for their amelioration in the future.

Copyright © 2002 S. Karger AG, Basel


 goto top of outline References
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 goto top of outline Author Contacts

Prof. Keith N. Frayn
Oxford Lipid Metabolism Group
Radcliffe Infirmary
Oxford, OX2 6HE (UK)
Tel. +44 1865 224180, Fax +44 1865 224652, E-Mail keith.frayn@oxlip.ox.ac.uk


 goto top of outline Article Information

Received: Received: October 14, 2001
Revised: July 30, 2002
Number of Figures : 2, Number of Tables : 2, Number of References : 100


 goto top of outline Publication Details

Medical Principles and Practice
International Journal of the Kuwait University Health Sciences Centre A Publicationof the Academic Publications Council

Vol. 11, No. Suppl. 2, Year 2002 (Cover Date: Released November 2002)

Journal Editor: Farida Al Awadi, Kuwait
ISSN: 1011–7571 (print), 1423–0151 (Online)

For additional information: http://www.karger.com/journals/mpp


Open Access License / Drug Dosage / Disclaimer

Open Access License: This is an Open Access article licensed under the terms of the Creative Commons Attribution-NonCommercial 3.0 Unported license (CC BY-NC) (www.karger.com/OA-license), applicable to the online version of the article only. Distribution permitted for non-commercial purposes only.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

Abstract

Objective: To review three ‘emerging risk factors’ for coronary heart disease, the physiological and pathophysiological mechanisms involved, and their inter-relationships. Background: Classical risk factors for coronary heart disease cannot adequately explain the high incidence of this disease. Abdominal obesity and impaired postprandial lipid metabolism have long been recognised as associates of coronary heart disease but only relatively recently has their importance as risk markers been established. Insulin resistance is now often seen as a common theme underlying many factors predisposing to coronary heart disease (CHD). Mechanisms: The mechanisms by which each of these markers relates to coronary heart disease may have common aspects. Specifically, they are all associated with a characteristic dyslipidaemia involving elevation of plasma triacylglycerol concentrations, reduction of high-density lipoprotein cholesterol (HDL-cholesterol) and the presence of small, dense low-density lipoprotein particles that may carry particular risk of atherogenesis. Insulin resistance is also associated with hypertension and impairment of endothelial function, and with a procoagulant state. Treatment: No specific or separate pharmacological treatment of any of these conditions separately has been shown to reduce the risk of CHD although each can be manipulated. Lifestyle modification, with increased physical activity and dietary change, may offer the best hope of primary prevention but to achieve this, interventions at government level rather than advice from individual physicians would probably be required. Conclusions: Abdominal obesity, impaired postprandial lipid metabolism and insulin resistance are all inter-related risk markers for CHD. They seem to reflect lifestyle in the developed and developing worlds and perhaps modification of lifestyle holds the greatest hope for their amelioration in the future.



 goto top of outline Author Contacts

Prof. Keith N. Frayn
Oxford Lipid Metabolism Group
Radcliffe Infirmary
Oxford, OX2 6HE (UK)
Tel. +44 1865 224180, Fax +44 1865 224652, E-Mail keith.frayn@oxlip.ox.ac.uk


 goto top of outline Article Information

Received: Received: October 14, 2001
Revised: July 30, 2002
Number of Figures : 2, Number of Tables : 2, Number of References : 100


 goto top of outline Publication Details

Medical Principles and Practice
International Journal of the Kuwait University Health Sciences Centre A Publicationof the Academic Publications Council

Vol. 11, No. Suppl. 2, Year 2002 (Cover Date: Released November 2002)

Journal Editor: Farida Al Awadi, Kuwait
ISSN: 1011–7571 (print), 1423–0151 (Online)

For additional information: http://www.karger.com/journals/mpp


Open Access License / Drug Dosage

Open Access License: This is an Open Access article licensed under the terms of the Creative Commons Attribution-NonCommercial 3.0 Unported license (CC BY-NC) (www.karger.com/OA-license), applicable to the online version of the article only. Distribution permitted for non-commercial purposes only.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

References

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