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Hello.
My name is Jean-Pierre Després.
I am the Director of
Research in Cardiology
at the Quebec Heart
and Lung Institute
I am also a professor in
the Department of Medicine
at the Université Laval
in Quebec City in Canada.
Today I will address the topic
of the metabolic syndrome.
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In 1988, at a landmark
lecture given
by Professor Gerald Reaven at
the annual meeting of the
American Diabetes Association,
he introduced the
notion of syndrome X,
or insulin resistance syndrome,
putting insulin resistance
as a core feature
of a constellation of
metabolic abnormalities,
increasing the risk of not only
developing type 2 diabetes,
but also cardiovascular disease.
He put forward the
hypothesis that insulin
resistance was a prevalent
metabolic abnormality,
substantially
increasing the risk of
cardiovascular disease
in our population.
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As hyperinsulinemia
is one marker
of an insulin-resistant state
in a non-diabetic individual,
we examined the
relationship between
elevated fasting insulin
level and risk of
coronary disease in
our prospective data
of middle-aged men followed
after the incidence
of a first coronary
heart disease event.
In the New England Journal
of Medicine in 1996,
we reported that,
as shown on the right
panel of this figure,
that the combination of
elevated insulin levels,
characterized by the top tertile
of fasting insulin levels,
was associated with a 3.2-fold
increased risk of
coronary disease.
There was a remarkable
increase in risk
of coronary disease
associated with
the simultaneous presence of
elevated insulin levels combined
with elevated ApoB
concentration.
This duo of metabolic
abnormalities is predictive
of an 11-fold increased risk
of coronary heart disease.
Making those two abnormalities,
that are features of syndrome
X or insulin resistance,
quite atherogenic.
We need to keep in mind, again,
