The metabolic syndrome: metabolic changes with vascular consequences

Despite criticism regarding its clinical relevance, the concept of the metabolic syndrome improves our understanding of both the pathophysiology of insulin resistance and its associated metabolic changes and vascular consequences. Free fatty acids (FFA) and tumour necrosis factor‐alpha (TNF‐α) play...

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Veröffentlicht in:	European journal of clinical investigation Jg. 37; H. 1; S. 8 - 17
Hauptverfasser:	Wassink, A. M. J., Olijhoek, J. K., Visseren, F. L. J.
Format:	Journal Article
Sprache:	Englisch
Veröffentlicht:	Oxford, UK Blackwell Publishing Ltd 01.01.2007 Blackwell
Schlagworte:	adipocyte dysfunction Adipocytes - metabolism Adiponectin Adiponectin - metabolism Biological and medical sciences cardiovascular risk Diabetes Mellitus, Type 2 - etiology Diabetic Angiopathies - etiology free fatty acids General aspects Humans insulin resistance Insulin Resistance - physiology Medical sciences Metabolic diseases Metabolic Syndrome - complications Metabolic Syndrome - metabolism Miscellaneous Obesity - etiology Obesity - metabolism Other metabolic disorders Risk Factors Tumor Necrosis Factor-alpha - physiology tumour necrosis factor-alpha Endocrinopathy Adipocyte adipocyte dysfunction Cytokine Metabolic diseases Cardiovascular disease free fatty acids Free fatty acid Change Insulin Adiponectin Vascular disease Medicine Target tissue resistance Dysfunction X Syndrome Blood vessel Atherosclerosis Risk factor Cardiovascular risk Insulin resistance Tumor necrosis factor α tumour necrosis factor-alpha
ISSN:	0014-2972, 1365-2362
Online-Zugang:	Volltext
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Zusammenfassung:	Despite criticism regarding its clinical relevance, the concept of the metabolic syndrome improves our understanding of both the pathophysiology of insulin resistance and its associated metabolic changes and vascular consequences. Free fatty acids (FFA) and tumour necrosis factor‐alpha (TNF‐α) play prominent roles in the development of insulin resistance by impairing the intracellular insulin signalling transduction pathway. Obesity is an independent risk factor for cardiovascular disease and strongly related to insulin resistance. In case of obesity, FFAs and TNF‐α are produced in abundance by adipocytes, whereas the production of adiponectin, an anti‐inflammatory adipokine, is reduced. This imbalanced production of pro‐ and anti‐inflammatory adipokines, as observed in adipocyte dysfunction, is thought to be the driving force behind insulin resistance. The role of several recently discovered adipokines such as resistin, visfatin and retinol‐binding protein (RBP)‐4 in the pathogenesis of insulin resistance is increasingly understood. Insulin resistance induces several metabolic changes, including hyperglycaemia, dyslipidaemia and hypertension, all leading to increased cardiovascular risk. In addition, the dysfunctional adipocyte, reflected largely by low adiponectin levels and a high TNF‐α concentration, directly influences the vascular endothelium, causing endothelial dysfunction and atherosclerosis. Adipocyte dysfunction could therefore be regarded as the common antecedent of both insulin resistance and atherosclerosis and functions as the link between obesity and cardiovascular disease. Targeting the dysfunctional adipocyte may reduce the risk for both cardiovascular disease and the development of type 2 diabetes. Although lifestyle intervention remains the cornerstone of therapy in improving insulin sensitivity and its associated metabolic changes, medical treatment might prove to be important as well.
Bibliographie:	ark:/67375/WNG-98FXKTNQ-M istex:A799FD5A26D68D422DBF68B769DCB22510DBAEA5 ArticleID:ECI1755 Department of Vascular Medicine, University Medical Centre Utrecht, The Netherlands (A. M. J. Wassink, J. K. Olijhoek, F. L. J. Visseren). ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0014-2972 1365-2362
DOI:	10.1111/j.1365-2362.2007.01755.x