Limits...
Epidemiology of type 2 diabetes and cardiovascular disease: translation from population to prevention: the Kelly West award lecture 2009.

Meigs JB - Diabetes Care (2010)

Bottom Line: West recognized that pre-diabetes is recognizable as what we now call metabolic syndrome.He predicted that type 2 diabetes could be prevented by healthy lifestyle change.The challenge now is for us to translate these insights into effective strategies for the prevention of the modern epidemic of diabetes and vascular disease.

View Article: PubMed Central - PubMed

Affiliation: General Internal Medicine Unit, Massachusetts General Hospital, Boston, Massachusetts, USA. jmeigs@partners.org

ABSTRACT
In the book Epidemiology of Diabetes and Its Vascular Lesions (1978), Kelly West summarized extant knowledge of the distribution and causes of diabetes. The 30 years of epidemiological research that followed have seen remarkable advances in the understanding of obesity as a risk factor for type 2 diabetes, and diabetes and pre-diabetes as risk factors for cardiovascular disease. Increasingly detailed understanding of these relationships has, unfortunately, been accompanied by an alarming increase in the prevalence of obesity, diabetes, and cardiovascular disease. West recognized that pre-diabetes is recognizable as what we now call metabolic syndrome. He predicted that novel insight into diabetes pathogenesis would come from biochemical and genetic epidemiology studies. He predicted that type 2 diabetes could be prevented by healthy lifestyle change. The challenge now is for us to translate these insights into effective strategies for the prevention of the modern epidemic of diabetes and vascular disease.

Show MeSH

Related in: MedlinePlus

Type 2 diabetes and CVD risk factor clustering is called metabolic syndrome. A: Shows that the observed co-occurrence of two or more of elevated fasting glucose (FG), fasting insulin (FI), triglycerides (TG), blood pressure (BP), BMI, or low HDL cholesterol (all defined in A as the extreme 20th percentile, light gray bars for women and dark gray bars for men) co-occur to a far greater degree than would be expected by change alone (compared with a binomial distribution, dashed line, P < 0.0001). B: Shows that the pattern of risk factor clustering for these risk factors (including, as well, glucose levels 2 h after an oral glucose tolerance test [2-h G] and waist-to-hip ratio [WHR]) represent three clinically identifiable phenotypes: impaired glucose tolerance (IGT), hypertension (HTN), and central obesity-dyslipidemia, linked together by obesity (in this figure, BMI) and fasting hyperinsulinemia (reflecting, in part, insulin resistance). C: Illustrates that obesity and insulin resistance constitute the common physiological antecedents leading to increased risk for the development of both type 2 diabetes (T2D) and CVD; the name currently applied to this phenomenon is metabolic syndrome. A and B are adapted from Wilson et al. (7) and Meigs et al. (8). DBP, diastolic blood pressure; SBP, systolic blood pressure.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC2909080&req=5

Figure 2: Type 2 diabetes and CVD risk factor clustering is called metabolic syndrome. A: Shows that the observed co-occurrence of two or more of elevated fasting glucose (FG), fasting insulin (FI), triglycerides (TG), blood pressure (BP), BMI, or low HDL cholesterol (all defined in A as the extreme 20th percentile, light gray bars for women and dark gray bars for men) co-occur to a far greater degree than would be expected by change alone (compared with a binomial distribution, dashed line, P < 0.0001). B: Shows that the pattern of risk factor clustering for these risk factors (including, as well, glucose levels 2 h after an oral glucose tolerance test [2-h G] and waist-to-hip ratio [WHR]) represent three clinically identifiable phenotypes: impaired glucose tolerance (IGT), hypertension (HTN), and central obesity-dyslipidemia, linked together by obesity (in this figure, BMI) and fasting hyperinsulinemia (reflecting, in part, insulin resistance). C: Illustrates that obesity and insulin resistance constitute the common physiological antecedents leading to increased risk for the development of both type 2 diabetes (T2D) and CVD; the name currently applied to this phenomenon is metabolic syndrome. A and B are adapted from Wilson et al. (7) and Meigs et al. (8). DBP, diastolic blood pressure; SBP, systolic blood pressure.

Mentions: From a clinical perspective, CVD is often viewed as a consequence of diagnosed type 2 diabetes. However, the experience of FHS and other cohorts has shown that pre-diabetes (defined by blood glucose levels below the diagnostic threshold for diabetes, but nonetheless not normal) is also associated with risk for cardiovascular disease (6). This observation has given rise to the notion that type 2 diabetes and CVD may share a common pathogenesis. Indeed, these diseases share many common risk factors, including obesity (especially central obesity), hyperinsulinemia (reflecting, in part, insulin resistance), hyperglycemia, a dyslipidemia characterized by low levels of HDL cholesterol and elevated levels of triglycerides, and elevated blood pressure. These measurable clinical traits are intercorrelated, co-occur to a far greater degree than would be expected by change alone, and cluster together in an identifiable pattern linked by obesity and insulin resistance (Fig. 2A and B) (7,8). This phenomenon of risk factor clustering is now called, for better or worse, metabolic syndrome (Fig. 2C). There are a variety of enthusiastically contested definitions of metabolic syndrome; in FHS, the definition proposed by the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATPII) is the one most often studied (9).


Epidemiology of type 2 diabetes and cardiovascular disease: translation from population to prevention: the Kelly West award lecture 2009.

Meigs JB - Diabetes Care (2010)

Type 2 diabetes and CVD risk factor clustering is called metabolic syndrome. A: Shows that the observed co-occurrence of two or more of elevated fasting glucose (FG), fasting insulin (FI), triglycerides (TG), blood pressure (BP), BMI, or low HDL cholesterol (all defined in A as the extreme 20th percentile, light gray bars for women and dark gray bars for men) co-occur to a far greater degree than would be expected by change alone (compared with a binomial distribution, dashed line, P < 0.0001). B: Shows that the pattern of risk factor clustering for these risk factors (including, as well, glucose levels 2 h after an oral glucose tolerance test [2-h G] and waist-to-hip ratio [WHR]) represent three clinically identifiable phenotypes: impaired glucose tolerance (IGT), hypertension (HTN), and central obesity-dyslipidemia, linked together by obesity (in this figure, BMI) and fasting hyperinsulinemia (reflecting, in part, insulin resistance). C: Illustrates that obesity and insulin resistance constitute the common physiological antecedents leading to increased risk for the development of both type 2 diabetes (T2D) and CVD; the name currently applied to this phenomenon is metabolic syndrome. A and B are adapted from Wilson et al. (7) and Meigs et al. (8). DBP, diastolic blood pressure; SBP, systolic blood pressure.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2909080&req=5

Figure 2: Type 2 diabetes and CVD risk factor clustering is called metabolic syndrome. A: Shows that the observed co-occurrence of two or more of elevated fasting glucose (FG), fasting insulin (FI), triglycerides (TG), blood pressure (BP), BMI, or low HDL cholesterol (all defined in A as the extreme 20th percentile, light gray bars for women and dark gray bars for men) co-occur to a far greater degree than would be expected by change alone (compared with a binomial distribution, dashed line, P < 0.0001). B: Shows that the pattern of risk factor clustering for these risk factors (including, as well, glucose levels 2 h after an oral glucose tolerance test [2-h G] and waist-to-hip ratio [WHR]) represent three clinically identifiable phenotypes: impaired glucose tolerance (IGT), hypertension (HTN), and central obesity-dyslipidemia, linked together by obesity (in this figure, BMI) and fasting hyperinsulinemia (reflecting, in part, insulin resistance). C: Illustrates that obesity and insulin resistance constitute the common physiological antecedents leading to increased risk for the development of both type 2 diabetes (T2D) and CVD; the name currently applied to this phenomenon is metabolic syndrome. A and B are adapted from Wilson et al. (7) and Meigs et al. (8). DBP, diastolic blood pressure; SBP, systolic blood pressure.
Mentions: From a clinical perspective, CVD is often viewed as a consequence of diagnosed type 2 diabetes. However, the experience of FHS and other cohorts has shown that pre-diabetes (defined by blood glucose levels below the diagnostic threshold for diabetes, but nonetheless not normal) is also associated with risk for cardiovascular disease (6). This observation has given rise to the notion that type 2 diabetes and CVD may share a common pathogenesis. Indeed, these diseases share many common risk factors, including obesity (especially central obesity), hyperinsulinemia (reflecting, in part, insulin resistance), hyperglycemia, a dyslipidemia characterized by low levels of HDL cholesterol and elevated levels of triglycerides, and elevated blood pressure. These measurable clinical traits are intercorrelated, co-occur to a far greater degree than would be expected by change alone, and cluster together in an identifiable pattern linked by obesity and insulin resistance (Fig. 2A and B) (7,8). This phenomenon of risk factor clustering is now called, for better or worse, metabolic syndrome (Fig. 2C). There are a variety of enthusiastically contested definitions of metabolic syndrome; in FHS, the definition proposed by the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATPII) is the one most often studied (9).

Bottom Line: West recognized that pre-diabetes is recognizable as what we now call metabolic syndrome.He predicted that type 2 diabetes could be prevented by healthy lifestyle change.The challenge now is for us to translate these insights into effective strategies for the prevention of the modern epidemic of diabetes and vascular disease.

View Article: PubMed Central - PubMed

Affiliation: General Internal Medicine Unit, Massachusetts General Hospital, Boston, Massachusetts, USA. jmeigs@partners.org

ABSTRACT
In the book Epidemiology of Diabetes and Its Vascular Lesions (1978), Kelly West summarized extant knowledge of the distribution and causes of diabetes. The 30 years of epidemiological research that followed have seen remarkable advances in the understanding of obesity as a risk factor for type 2 diabetes, and diabetes and pre-diabetes as risk factors for cardiovascular disease. Increasingly detailed understanding of these relationships has, unfortunately, been accompanied by an alarming increase in the prevalence of obesity, diabetes, and cardiovascular disease. West recognized that pre-diabetes is recognizable as what we now call metabolic syndrome. He predicted that novel insight into diabetes pathogenesis would come from biochemical and genetic epidemiology studies. He predicted that type 2 diabetes could be prevented by healthy lifestyle change. The challenge now is for us to translate these insights into effective strategies for the prevention of the modern epidemic of diabetes and vascular disease.

Show MeSH
Related in: MedlinePlus