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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.

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Related in: MedlinePlus

Metabolic syndrome (MetS) is a risk factor for both type 2 diabetes (T2D) and CVD. A: Shows that among men in FHS, the 7- to 11-year risk for CVD increases from 1.5 for those with one or two MetS risk factors (RFs) to 4.0 for those with three or more (that is, with MetS) relative to those with no MetS risk factors, even after accounting for other CVD–specific risk factors. The bars in the figure represent the odds ratio and its 95% confidence bounds. The relative risk for CVD is 2.9 comparing MetS vs. no MetS. Risk for type 2 diabetes increases from 4.2 for men with one or two MetS risk factors to 24 for those with MetS relative to those with no MetS risk factors, even after accounting for other type 2 diabetes–specific risk factors. The relative risk for type 2 diabetes is 6.9 comparing MetS vs. no MetS. Patterns are similar for FHS women. Risk rises steadily in a dose-response relationship as the number of component traits increases and is increased regardless of which of the various heterogeneous combinations of specific traits are present, and even in the absence of impaired glycemia (B) (adapted from Wilson et al. [10]). BP, blood pressure; FG, fasting glucose; TG, triglycerides.
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Figure 3: Metabolic syndrome (MetS) is a risk factor for both type 2 diabetes (T2D) and CVD. A: Shows that among men in FHS, the 7- to 11-year risk for CVD increases from 1.5 for those with one or two MetS risk factors (RFs) to 4.0 for those with three or more (that is, with MetS) relative to those with no MetS risk factors, even after accounting for other CVD–specific risk factors. The bars in the figure represent the odds ratio and its 95% confidence bounds. The relative risk for CVD is 2.9 comparing MetS vs. no MetS. Risk for type 2 diabetes increases from 4.2 for men with one or two MetS risk factors to 24 for those with MetS relative to those with no MetS risk factors, even after accounting for other type 2 diabetes–specific risk factors. The relative risk for type 2 diabetes is 6.9 comparing MetS vs. no MetS. Patterns are similar for FHS women. Risk rises steadily in a dose-response relationship as the number of component traits increases and is increased regardless of which of the various heterogeneous combinations of specific traits are present, and even in the absence of impaired glycemia (B) (adapted from Wilson et al. [10]). BP, blood pressure; FG, fasting glucose; TG, triglycerides.

Mentions: A fundamental hypothesis raised by the concept of metabolic syndrome is that its presence increases future risk for both type 2 diabetes and CVD, even after accounting for other disease-specific risk factors. In FHS, metabolic syndrome increases the 7- to 11-year risk for CVD in men by about threefold relative to those without metabolic syndrome, and for type 2 diabetes, the increase is about sevenfold (Fig. 3A) (10). Associations among women are similar. Risk rises steadily in a dose-response relationship as the number of component traits increases. Further, risk is increased regardless of which of the various heterogeneous combinations of specific traits are present and even in the absence of impaired glycemia. For instance, in individuals with the combination of low HDL cholesterol and elevated triglycerides and blood pressure but without impaired glycemia, the relative risk for CVD is about twofold increased relative to those without this trait combination, and for type 2 diabetes, the relative risk is 3.5-fold increased (Fig. 3B). The data suggest that beyond the specific risk factors that may be present, it is something about the phenomenon of risk factor clustering itself that appears to account, at least in part, for subsequent disease risk. Metabolic syndrome also accounts for some of the heterogeneity for future disease risk observed in individuals with obesity. Among FHS individuals with BMI <25 kg/m2 who meet the criteria for metabolic syndrome, the 7-year cumulative incidence of type 2 diabetes was about 7%, while among those with BMI ≥30 kg/m2 but without metabolic syndrome, the rate was only about 3% (11). These individuals can be considered to represent “metabolically obese, normal weight” and “metabolically healthy obese” subphenotypes, respectively. Similar albeit less dramatic patterns were seen for risk of CVD. If there is one obvious lesson that can be drawn from the studies of metabolic syndrome, it is that that metabolic syndrome is a far more powerful risk factor for type 2 diabetes than for CVD.


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

Meigs JB - Diabetes Care (2010)

Metabolic syndrome (MetS) is a risk factor for both type 2 diabetes (T2D) and CVD. A: Shows that among men in FHS, the 7- to 11-year risk for CVD increases from 1.5 for those with one or two MetS risk factors (RFs) to 4.0 for those with three or more (that is, with MetS) relative to those with no MetS risk factors, even after accounting for other CVD–specific risk factors. The bars in the figure represent the odds ratio and its 95% confidence bounds. The relative risk for CVD is 2.9 comparing MetS vs. no MetS. Risk for type 2 diabetes increases from 4.2 for men with one or two MetS risk factors to 24 for those with MetS relative to those with no MetS risk factors, even after accounting for other type 2 diabetes–specific risk factors. The relative risk for type 2 diabetes is 6.9 comparing MetS vs. no MetS. Patterns are similar for FHS women. Risk rises steadily in a dose-response relationship as the number of component traits increases and is increased regardless of which of the various heterogeneous combinations of specific traits are present, and even in the absence of impaired glycemia (B) (adapted from Wilson et al. [10]). BP, blood pressure; FG, fasting glucose; TG, triglycerides.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

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

Figure 3: Metabolic syndrome (MetS) is a risk factor for both type 2 diabetes (T2D) and CVD. A: Shows that among men in FHS, the 7- to 11-year risk for CVD increases from 1.5 for those with one or two MetS risk factors (RFs) to 4.0 for those with three or more (that is, with MetS) relative to those with no MetS risk factors, even after accounting for other CVD–specific risk factors. The bars in the figure represent the odds ratio and its 95% confidence bounds. The relative risk for CVD is 2.9 comparing MetS vs. no MetS. Risk for type 2 diabetes increases from 4.2 for men with one or two MetS risk factors to 24 for those with MetS relative to those with no MetS risk factors, even after accounting for other type 2 diabetes–specific risk factors. The relative risk for type 2 diabetes is 6.9 comparing MetS vs. no MetS. Patterns are similar for FHS women. Risk rises steadily in a dose-response relationship as the number of component traits increases and is increased regardless of which of the various heterogeneous combinations of specific traits are present, and even in the absence of impaired glycemia (B) (adapted from Wilson et al. [10]). BP, blood pressure; FG, fasting glucose; TG, triglycerides.
Mentions: A fundamental hypothesis raised by the concept of metabolic syndrome is that its presence increases future risk for both type 2 diabetes and CVD, even after accounting for other disease-specific risk factors. In FHS, metabolic syndrome increases the 7- to 11-year risk for CVD in men by about threefold relative to those without metabolic syndrome, and for type 2 diabetes, the increase is about sevenfold (Fig. 3A) (10). Associations among women are similar. Risk rises steadily in a dose-response relationship as the number of component traits increases. Further, risk is increased regardless of which of the various heterogeneous combinations of specific traits are present and even in the absence of impaired glycemia. For instance, in individuals with the combination of low HDL cholesterol and elevated triglycerides and blood pressure but without impaired glycemia, the relative risk for CVD is about twofold increased relative to those without this trait combination, and for type 2 diabetes, the relative risk is 3.5-fold increased (Fig. 3B). The data suggest that beyond the specific risk factors that may be present, it is something about the phenomenon of risk factor clustering itself that appears to account, at least in part, for subsequent disease risk. Metabolic syndrome also accounts for some of the heterogeneity for future disease risk observed in individuals with obesity. Among FHS individuals with BMI <25 kg/m2 who meet the criteria for metabolic syndrome, the 7-year cumulative incidence of type 2 diabetes was about 7%, while among those with BMI ≥30 kg/m2 but without metabolic syndrome, the rate was only about 3% (11). These individuals can be considered to represent “metabolically obese, normal weight” and “metabolically healthy obese” subphenotypes, respectively. Similar albeit less dramatic patterns were seen for risk of CVD. If there is one obvious lesson that can be drawn from the studies of metabolic syndrome, it is that that metabolic syndrome is a far more powerful risk factor for type 2 diabetes than for CVD.

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