In this presentation Prof. Haffner talks about the metabolic syndrome and its components in relation to diabetes and CVD risk, and approaches to therapy.

Even before the clinical diagnosis of type 2 diabetes there is an already increased risk of CVD as was seen in the Nurses' Health Study (1). In the San Antonio Heart Study it was possible to look at the heterogeneity of prediabetic subjects in terms of the presence of high insulin resistance, low insulin secretion or both defects, and to assess differences in risk factor profiles. Insulin resistance as assessed by the homeostasis model (HOMA-IR) was found in this study to be associated with CVD risk (2).

Levels of C-reactive protein (CRP), a marker of inflammation, have been found to increase with increasing numbers of metabolic syndrome components (3) and CRP has also been found to predict the development of type 2 diabetes (4). Prof. Haffner talks about different diabetes prevention strategies and ongoing clinical trials.

How strong is metabolic syndrome as a predictor of CVD risk? A Finnish study published by Lakka et al. suggested a relative 3.5-fold increased risk of CVD mortality (5), whereas in the San Antonio Heart Study it was only found to be about 2-fold (6). Prof. Haffner discusses how this might be due in part to differences in the prevalence of metabolic syndrome components and their individual associated risks, and ends with some ideas on approaches to therapy for the metabolic syndrome.

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After viewing this presentation the participant will be able to discuss:

- Differences in risk factor profiles among prediabetic individuals
- Inflammation and the metabolic syndrome
- Diabetes prevention strategies
- Metabolic syndrome as predictor of CVD risk in different populations
- Approaches to therapy for the metabolic syndrome

1. Hu FB, Stampfer MJ, Haffner SM, Solomon CG, Willett WC, Manson JE. Elevated Risk of Cardiovascular Disease Prior to Clinical Diagnosis of Type 2 Diabetes. Diabetes Care 25:1129-1134, 2002.

2. Anthony J.G. Hanley, PhD, Ken Williams, MSc, Michael P. Stern, MD and Steven M. Haffner, MD. Homeostasis Model Assessment of Insulin Resistance in Relation to the Incidence of Cardiovascular Disease: The San Antonio Heart Study. Diabetes Care 25:1177-1184, 2002.

3. Andreas Festa, MD; Ralph D’Agostino, Jr, PhD; George Howard, DrPH; Leena Mykkänen, MD, PhD; Russell P. Tracy, PhD; Steven M. Haffner, MD. Chronic Subclinical Inflammation as Part of the Insulin Resistance Syndrome:The Insulin Resistance Atherosclerosis Study (IRAS). Circulation. 2000;102:42.

4. Festa A, D'Agostino R Jr, Tracy RP, Haffner SM; Insulin Resistance Atherosclerosis Study. Elevated Levels of Acute-Phase Proteins and Plasminogen Activator Inhibitor-1 Predict the Development of Type 2 Diabetes: The Insulin Resistance Atherosclerosis Study. Diabetes. 2002 Apr;51(4):1131-7.

5. Hanna-Maaria Lakka, MD, PhD; David E. Laaksonen, MD, MPH; Timo A. Lakka, MD, PhD; Leo K. Niskanen, MD, PhD; Esko Kumpusalo, MD, PhD; Jaakko Tuomilehto, MD, PhD; Jukka T. Salonen, MD, PhD The Metabolic Syndrome and Total and Cardiovascular Disease Mortality in Middle-aged Men. JAMA. 2002;288:2709-2716.

6. Kelly J. Hunt, PhD; Roy G. Resendez, MA; Ken Williams, MS; Steve M. Haffner, MD; Michael P. Stern, MD. National Cholesterol Education Program Versus World Health Organization Metabolic Syndrome in Relation to All-Cause and Cardiovascular Mortality in the San Antonio Heart Study. Circulation. 2004;110:1251-1257.