Endocrine Abstracts

There is increasing interest in insulin resistance as a candidate pathway in the pathogenesis of vascular disease. Part of this interest stems from the rapidly increasing rates of obesity worldwide which fuel insulin resistance particularly in susceptible 'at risk' individuals. Insulin resistance is associated with a plethora of metabolic perturbances (dyslipidaemia, hypertension, abnormal haemostasis, low grade inflammation, altered adipokine levels) and many of these abnormalities can directly or indirectly accelerate the atherogenic process, often well in advance of glucose dysregulation. There is thus great clinical interest in assessing the degree of insulin resistance in an attempt to improve risk prediction for vascular disease. Direct measurements of insulin resistance are generally unsuitable for widespread clinical use. Rather simple criteria based on readily measured factors associated with insulin resistance have been proposed under the broader term of 'metabolic syndrome'. Abundant data suggest such metabolic syndrome criteria (NCEP and WHO) predict CHD events and more strongly risk for type 2 diabetes. However, further work is required to refine existing criteria to better predict CHD events and to scrutinise clinical application. Whether adipokine measurements help in this regards is a focus of intense interest. At present, however, perhaps the major accomplishment of the metabolic syndrome concept has been to alert clinicians to a common clustering of risk factors for vascular disease. Finally, ongoing clinical trials will determine the role of lifestyle factors and insulin sensitising agents in reducing risk of disease in subjects with metabolic syndrome associated risk factors.