The metabolic syndrome

Published on May 22, 2013   61 min

Other Talks in the Series: Diabetes in Perspective

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.
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.
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,