The obesity, metabolic syndrome, and type 2 diabetes mellitus pandemic: Part I. Increased cardiovascular disease risk and the importance of atherogenic dyslipidemia in persons with the metabolic syndrome and type 2 diabetes mellitus

Abstract

Both the metabolic syndrome (MS) and type 2 diabetes mellitus (T2DM) confer an increased risk of coronary heart disease and cardiovascular disease (CVD). As MS and T2DM become more prevalent, there will be an associated rise in the number of individuals with or at risk for CVD and its related disorders. One major underlying cause of CVD in patients with MS or T2DM is a characteristic form of atherogenic dyslipidemia. This article reviews the evidence that demonstrates that individuals with MS or T2DM are at increased risk for CVD and highlights atherogenic dyslipidemia as an important risk factor for the development of CVD in these individuals. In an accompanying article, current pharmacotherapies available for the management of atherogenic dyslipidemia in individuals with MS or T2DM are discussed.

Figure 1

Estimates of relative risk for cardiovascular disease (CVD) and diabetes reported in prospective studies in samples from the general population using definitions of the metabolic syndrome (MS) developed by the National Cholesterol Education Program (NCEP) (adapted from Ford, 200517) (A) Associations between MS (using the NCEP definition) and CVD. (B) Associations between MS (using the NCEP definition) and diabetes.

Figure 2

(A) Age-adjusted prevalence of coronary heart disease (CHD) in the US population older than 50 years according the presence of the metabolic syndrome (MS) and diabetes mellitus (DM) (adapted from Alexander et al, 200312). (B) Prevalence of patients with major cardiovascular disease events in all patients in the Treating to New Targets study by MS and DM status (adapted from Deedwania et al, 200620). *Hazard ratio for patients with MS and diabetes vs patients without MS or diabetes. †Hazard ratio for patients with MS without diabetes vs patients without MS or diabetes.

Figure 3

Incidence of coronary heart disease (CHD) per 1000 persons over a period of 6 years according to the high-density lipoprotein cholesterol (HDL-C) level (adapted from Assmann et al, 1996.