Insulin Resistance, Cardiovascular Disease, and the Metabolic Syndrome
How well do the emperor’s clothes fit?
- Gerald M. Reaven, MD
- From the Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California
- Address correspondence to Gerald Reaven, MD, Division of Cardiovascular Medicine, Falk CVRC, Stanford Medical Center, 300 Pasteur Dr., Stanford, CA 94305. E-mail: greaven{at}cvmed.stanford.edu
The recent report of the Adult Treatment Panel (ATP III) of the National Cholesterol Education Program (1) identified as cardiovascular disease (CVD) risk factors what they referred to as a “constellation of lipid and nonlipid risk factors of metabolic origin,” indicated that “this syndrome is closely related to insulin resistance,” and proposed diagnostic criteria for what they designated as “the metabolic syndrome.” Since the publication of these criteria, studies have been published defining the prevalence of the metabolic syndrome in various populations (2) and the degree to which a positive diagnosis of the metabolic syndrome predicts CVD risk (3). However, the possibility that a substantial number of individuals who do not satisfy the ATP III criteria might be sufficiently insulin resistant to be at significant increased CVD risk has not been considered and neither has the ability of the ATP III criteria to identify insulin-resistant individuals been evaluated. These issues were both addressed by Liao et al. (4) in this issue of Diabetes Care, and their results indicate that the “ATP III criteria have low sensitivity for identifying insulin resistance with dyslipidemia in nondiabetic subjects who are at increased risk for cardiovascular disease and diabetes.”
The study by Liao et al., performed in 74 apparently healthy, nondiabetic volunteers, found that 12.2% of their population met ATP III criteria for the metabolic syndrome, a value considerably lower than that previously reported (2). However, the prevalence of the metabolic syndrome based on the Third National Health and Nutrition Examination Survey database included patients with diabetes …
