The interplay of cardiovascular risk factors in the metabolic syndrome and type 2 diabetes
Department of Medicine, University College London Medical School, London, UK
* Correspondence: D.J. Betteridge, Department of Medicine, University College London Medical School, London, UK. Tel.: +44 207 679 9444; fax: +44 207 679 9192/9440 (E-mail: j.betteridge{at}ucl.ac.uk).
Abstract
Cardiovascular disease (CVD) is the major cause of morbidity and mortality in the western world, and patients with diabetes have a 2- to 3-fold greater risk of CVD death than those without. This suggests an interaction between diabetes and other CVD risk factors such as hypertension and dyslipidaemia. The treatment of CVD risk factors in patients with diabetes reduces the incidence of CVD death but macrovascular damage is present in patients prior to the onset of overt diabetes, so the early identification and treatment of patients at risk of diabetes is essential for the primary prevention of CVD. Risk factors for diabetes and CVD are more likely to occur simultaneously than would be expected by chance, and this cluster of disorders is collectively called the metabolic syndrome. Individuals with the metabolic syndrome have an increased risk of CVD prior to the development of impaired glucose tolerance and diabetes, and patients with both the metabolic syndrome and diabetes are at greater risk of coronary heart disease death than patients with either diabetes or the metabolic syndrome alone. Although reducing glucose levels significantly reduces the risk of microvascular disease in patients with diabetes and/or the metabolic syndrome, it is not sufficient to significantly reduce the incidence of macrovascular disease. Additional risk factors, including hypertension and dyslipidaemia, must also be targeted in patients with these disorders.
Keywords Cardiovascular disease; Diabetes; Dyslipidaemia; Metabolic syndrome