SINDROME METABOLICO 1: Am J Med. 2007 Mar;120(3 Suppl 1):S12-8. Links

1: Am J Med. 2007 Mar;120(3 Suppl 1):S12-8.
Links
Effect of insulin resistance, dyslipidemia, and intra-abdominal adiposity on the development of cardiovascular disease and diabetes mellitus.
· Rader DJ.
Institute for Diabetes, Obesity, and Metabolism, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA. rader@mail.med.upenn.edu
Abdominal obesity contributes to insulin resistance, a metabolic abnormality linked to the development of type 2 diabetes mellitus and cardiovascular disease (CVD). Insulin resistance generally precedes the development of type 2 diabetes. Currently, an estimated 10 million US adults have diabetes and another 25 million have impaired glucose tolerance (IGT), an intermediate step between insulin resistance and diabetes. The pathophysiologic mechanisms known to increase CVD risk in individuals with insulin resistance include formation of advanced glycation end products, hypertension, proinflammatory and prothrombotic states, and dyslipidemia (i.e., low levels of high-density lipoprotein cholesterol, increased levels of triglycerides, small, dense low-density lipoprotein cholesterol particles, apoplipoprotein B, and inflammation). The increased flux of free fatty acids from adipose tissue to the liver promotes dyslipidemia. Insulin resistance and impaired glucose tolerance are associated with increased CVD risk. Individuals with coexisting metabolic syndrome and diabetes have the highest prevalence rates of CVD. The Nurses' Health Study showed that CVD risk was elevated even before the development of diabetes compared with women who never developed diabetes. Lifestyle modification is recommended as the first-line treatment for obesity and its metabolic sequelae. Pharmacotherapy may be useful in patients for whom nonpharmacologic approaches alone are ineffective or insufficient. Primary care physicians play a critical role in the early identification and treatment of patients at increased risk for the development of type 2 diabetes and CVD because of their obesity and associated complications.
PMID: 17320517 [PubMed - indexed for MEDLINE]
TRADUCCION: La obesidad abdominal contribuye a la insulinoresistencia una anormalidad metabólica ligada al desarrollo de Diabetes Mellitas tipo II y enfermedad cardiovascular(CVD). La insulinorewsistencia generalmente precede al desarrollo de Diabetes Mellitas . Actualmente una estimación de 10 millones de Norteamericanos tiene diabetes y 25 millones alterada tolerancia a la glucosa (IGT) e intermedios estados entre insulinoresistencia y diabetes. Los mecanismos fisiopatológicos conocidos que elevan el riesgo cardiovasculat en individuos con insulinoresistencia incluye la formación de productos de glicación avanzada, hipertension, estados proinflamatorios y protrombóticos y dislipidemia ( lipoproteínas de alta densidad, aumento de los niveles de triglicéridos pequeñas densas partículas de LDL, apolipoproteínasB e inflamación). El elevado flujo de ácidos grasos desde los depósitos adiposos hacia el hígado promueve la dislipidemia. La insulinoresistencia y la alteración de la tolerancia a la glucose esta asociada a un aumento del riesgo de enfermedad cardiovascular. Los individuos en quienes coexiste diabetes y síndrome metabólico tioenen altos niveles de Enfermedad Cardiovascular. Los estudios de salud muetran que el riesgo cardiovascular es elevado aun antes que se desarrolle la diabetes. Modificación en el estilo de vida son erecdomendados como primera linea de tratamiento de las secuelas de la obesidad y el síndrome metabólico. Polifarmacoterapia puede ser util en pacientes en quienes fármacos solos son inefectivos e insuficientes.