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Query: UMLS:C0242339 (dyslipidemia)
 13,927 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Insulin resistance is a major component of non-insulin-dependent diabetes mellitus (NIDDM). While a genetic contribution is likely, as yet none of several proposed candidate genes have been incriminated in the typically obese patient with NIDDM to explain their insulin resistance. Accordingly, this review focuses on some recent advances in understanding three acquired factors contributing to insulin resistance: visceral obesity, glucotoxicity and lipotoxicity. Newer computerized tomography scans allow quantitation of fat accumulating in visceral organs including the mesentery and omentum. This visceral fat relates much more to the insulin resistance syndrome than does subcutaneous fat. Moreover, exercise, as performed by active Sumo wrestlers, is associated with low visceral fat, absent hyperglycemia and absent dyslipidemia despite massive subcutaneous obesity. It remains to be seen whether exercise programs more moderate than Sumo wrestling will also mobilize visceral fat. A new metabolic pathway has recently been described whereby hexosamines are formed by an increased flux of glucose into fat and muscle. These hexosamine products appear to explain how glucotoxicity results in insulin resistance. They act as a negative feedback system to limit further glucose transport by insulin target tissue during hyperglycemia. Lipotoxicity has previously been implicated in insulin resistance by its inhibitory effect on glucose uptake by muscle because of the Randle-fatty acid cycle. Recently the role of elevated fatty acids in producing "hepatic" resistance to insulin in NIDDM has also been documented, but the site of insulin resistance may be the fat cell rather than the hepatocyte. Therapy consists mainly of hygienic measures, including caloric restriction and exercise, which can reverse all three of these acquired forms of insulin resistance. In addition, pharmacologic measures to reduce hyperglycemia can reduce the glucotoxicity and lipotoxicity. The use of insulin-sparing antihyperglycemia drugs may be particularly useful in the insulin-resistant patient to avoid weight gain while correcting the hyperglycemia.
Horm Metab Res 1996 Sep
PMID:Reversible insulin resistance in non-insulin-dependent diabetes mellitus. 891 80

Secondary prevention of arteriosclerosis tries to inhibit progression of the atherosclerotic process. Therapeutic measures focus on modification of cardiovascular risk factors and antithrombotic treatment. Hypercholesterolemia is the main risk factor for coronary artery disease. The risk of a coronary event is correlated to the plasma cholesterol level. Lowering plasma cholesterol results in reduction of vascular morbidity and mortality. Cigarette smoking is the predominant risk factor for peripheral arterial occlusive disease (PAOD). Smoking cessation reduces progression of PAOD and lowers cardiovascular morbidity and mortality. The preventive effect of antihypertensive therapy in hypertensive patients is most pronounced for cerebrovascular events. Antihypertensive measures improve prognosis after stroke and myocardial infarction. The increased cardiovascular risk in diabetics is in part explained by hyperglycemia and hyperinsulinemia, but also depends on coexisting dyslipidemia and hypertension. Intensive treatment of elevated blood glucose levels, dyslipidemia and hypertension are important preventive measures. Aspirin is highly effective in secondary prevention of vascular events. For the coronary arteries, low-dose aspirin is well established. Whether low-dose aspirin is equally effective for reducing progression of arteriosclerosis in the cerebrovascular and in the peripheral vessels is questionable. Ticlopidine serves as an alternative to aspirin; however, neutropenia may occur, which requires supervision of the patient.
Praxis (Bern 1994) 1996 Sep 24
PMID:[Secondary prevention of arteriosclerosis]. 892 4

Insulin resistance has been proposed as the metabolic basis of atherogenesis. This hypothesis is based on the concept of the "insulin resistance syndrome," according to which insulin resistance is viewed as the primary abnormality that gives rise to dyslipidemia, essential hypertension, impaired glucose tolerance, and NIDDM. However, this hypothesis takes no account of the well-established and central role of vascular endothelium in the atherogenic process. Although endothelial injury is an early and prominent feature of atherogenesis, relatively little attention has been given to its metabolic consequences. In subjects with NIDDM, we have shown that endothelial dysfunction is associated with insulin resistance, raising the question of whether this relationship could be causal. In this article, we review the factors that are considered to be responsible for the development of endothelial dysfunction during atherogenesis, together with the metabolic consequences of endothelial dysfunction. While dysfunction of the endothelium in large and medium-sized arteries plays a central role in atherogenesis, we argue that dysfunction of peripheral vascular endothelium, at arteriolar and capillary level, plays the primary role in the pathogenesis of both insulin resistance and the associated features of the insulin resistance syndrome. We propose that the insulin resistance syndrome, together with many aspects of atherogenesis, can be viewed as the diverse consequences of endothelial dysfunction in different vascular beds. This new and testable hypothesis accounts for both the endothelial and metabolic abnormalities associated with atherogenesis.
Diabetes 1997 Sep
PMID:Endothelial dysfunction: cause of the insulin resistance syndrome. 928 92

The effect of changes in physical activity levels during chronic exercise on plasma lipids and lipoproteins has not been reported. We examine the relationships between changes in VO2max, leisure time physical activity (LTPA), and percent body fat on changes in plasma lipids and lipoproteins in 137 men without coronary artery disease (CAD) and/or dyslipidemia, hypertension, or diabetes mellitus who participated in an employee exercise program. Measurements obtained at entry and 1- and 4-yr follow-up include VO2max, LTPA in kcal.wk-1, percent body fat, and plasma lipids and lipoproteins. The relationship between changes in the measurements between 1 and 4 yr of follow-up (N = 34) revealed the following significant (P < 0.05) correlations: i) changes in VO2max with changes in percent body fat (r = -0.289) and changes in plasma triglycerides (r = -0.354), ii) changes in LTPA with changes in percent body fat (-0.361), and iii) changes in percent body fat with changes in the total/high density lipoprotein (HDL)-cholesterol ratio (0.358), HDL-cholesterol (-0.212), and triglycerides (0.289). Multiple regression analysis revealed that changes in percent body fat affected changes in plasma triglycerides (P < 0.05). The effects of chronic physical activity on plasma triglycerides appear to result from exercise-related effects on body adiposity. These findings support the role of regular physical activity as mandated by Healthy People 2000 for CAD risk reduction.
Med Sci Sports Exerc 1997 Sep
PMID:Changes in VO2max, physical activity, and body fat with chronic exercise: effects on plasma lipids. 930 25

This study examined, through a randomized controlled trial, the effects of cross-training (combined resistance and endurance exercise) on markers of insulin resistance, (e.g., dyslipidemia, intra-abdominal obesity, hyperinsulinemia, and hypertension), body composition, and performance in hyperinsulinemic individuals. Sedentary adult males characterized as hyperinsulinemic (fasting insulin > 2 OuU.mL-1), randomly assigned to two groups (N = 8 each), completed 14 wk of training at 3 d.wk-1. An endurance-only (E) group performed both continuous cycle exercise and walking (30 min each at 60-70% heart rate reserve). A cross-training (C) group performed both endurance and resistance exercise (8 exercises, 4 sets/exercise, 8-12 repetitions/set) in a single session. Both E and C groups demonstrated similar increases in VO2max (25% and 27%) while only C demonstrated an increase in 1 RM bench press (19%) and leg press (25%). The changes induced by C training were significantly greater than those from E training alone in percent fat (6.9 +/- 1.3 vs 1.4 +/- 1.4), insulin concentration (8.5 +/- 2.7 vs 3.0 +/- 1.3 uU.mL-1), glucose levels (11.1 +/- 2.9 vs 5.9 +/- 2.6 mg.dL-1), HDL-C levels (5.1 +/- 1.3 vs 2.9 +/- 1.6 mg.dL-1), triglyceride concentration (43.8 +/- 13.6 mg.dL-1), and systolic blood pressure (14.6 +/- 5.5 vs 8.3 +/- 6.8 mm Hg). Results indicate that the addition of resistance training to an endurance training program will induce significantly greater differences in markers of insulin resistance and body composition in individuals with hyperinsulinemia than endurance training alone.
Med Sci Sports Exerc 1997 Sep
PMID:Effects of cross-training on markers of insulin resistance/hyperinsulinemia. 930 27

The thiazolidinediones are a unique class of compounds that exert direct effects on the mechanisms of insulin resistance and result in improved insulin action and reduced hyperinsulinemia. Troglitazone is the first of these compounds to be approved for use in humans and has the potential not only to reduce glycemia and insulin requirements in type II diabetes but to improve other components of the insulin resistance syndrome including dyslipidemia, hypertension, and accelerated cardiovascular disease. Such compounds also hold promise for the prevention of type II diabetes and for the treatment of other insulin-resistant states including polycystic ovary disease. In addition to the novel mechanism of action through binding and activation of PPARs, troglitazone has other unique advantages, including once-a-day administration, a low incidence of minor side effects, no known drug interactions, hepatic metabolism and secretion, and potent antioxidant properties. Thiazolidinedione compounds such as troglitazone provide an important additional resource for the health care provider in the management of type II diabetes and other components of the insulin resistance syndrome.
Endocrinol Metab Clin North Am 1997 Sep
PMID:Thiazolidinediones. 931 15

Japanese individuals living outside Japan are more susceptible to chronic diseases included in the insulin resistance syndrome. Hyperinsulinemia and hypertension are associated, but large studies adjusting for confounders are still required. The present evaluated if insulin (I) or proinsulin (PI) was associated with hypertension after adjustment for other risk factors, in first (n=238) and second (n=292) generation Japanese-Brazilians, aged 40 to 79 years, living in a developed city in Brazil. Blood pressure (BP) was measured by random-zero sphygmomanometry. People with mean systolic/diastolic BP >140/90 mm Hg or taking antihypertensive drugs were considered hypertensive. Diagnosis of diabetes was based on results of an oral glucose tolerance test using WHO criteria. I and PI after fasting and 2 hours after glucose load were determined by specific immunofluorimetric assays. The first generation was older than the second (65.6+/-9.2 versus 53.6+/-8.4 years, P<.01) and male/female ratios were 1.14 and 0.87, respectively. The age-adjusted prevalence of hypertension was 29.2% with no difference between sexes or generations. Higher body mass index (25.2+/-4.3 versus 23.8+/-3.3 kg/m2), waist-to-hip ratio (0.939+/-0.067 versus 0.919+/-0.073), plasma glucose (6.3+/-2.3 versus 5.6+/-1.8 mmol/L), cholesterol (5.74+/-1.19 versus 5.48+/-1.08 mmol/L), and creatinine (74+/-26 versus 83+/-36 micromol/L) were found among the hypertensives (P<.05). Univariate analyses showed associations of obesity, diabetes, and dyslipidemia with hypertension. Logistic regression analyses demonstrated that 2-hour I (OR, 1.22; 95% CI, 1.02 to 1.46) and fasting PI (OR, 1.14; 95% CI, 1.00 to 1.31) remained significantly associated with hypertension, after adjustment for age, sex, generation, family history of hypertension, smoking habits, waist-to-hip ratio, serum creatinine, glucose intolerance, and dyslipidemia. Japanese-Brazilians have a higher prevalence of hypertension than the general population in Brazil. High levels of 2-hour I, seen in hypertensives, may be interpreted as independent risk factors for hypertension in this population. Our findings suggest that fasting PI should be useful, in addition to insulin, to assess risk factors for hypertension in epidemiological studies.
Hypertension 1997 Sep
PMID:Is insulin or its precursor independently associated with hypertension? An epidemiological study in Japanese-Brazilians. 932 96

Insulin resistance is associated with a variety of cardiovascular risk factors including hypertension, dyslipidemia, and non-insulin-dependent diabetes. In blacks, the relation between insulin resistance, hypertension, and atherosclerosis has been questioned. Most data collected on the Insulin Resistance Syndrome have been collected in nondiabetic subjects; therefore, no inference can be drawn to exogenous insulin use in diabetic subjects where improved glycemic control is usually associated with improved cardiovascular risk factors (especially dyslipidemia) in the absence of weight gain.
Ann N Y Acad Sci 1997 Sep 20
PMID:Progress in population analyses of the insulin resistance syndrome. 932 38

For the first time, we have techniques available that may enable us to determine cause and effect in common cardiovascular diseases. The observations presented herein require cautious interpretation until replicated. There are currently several large programs under way that seek to establish substantial family resources for investigation of the genetic basis of hypertension. When interpreting the results of genome screens, it will be necessary to consider that we may link genetic loci for coexistent features such as dyslipidemia and insulin resistance to hypertension. Therefore, careful phenotypic data will be necessary to dissect out the causes of hypertension.
Ann N Y Acad Sci 1997 Sep 20
PMID:Progress in determining the genes for hypertension, insulin resistance, and dyslipidemia. 932 46

Authors summarise their 5-year long experiences on 343 patients about diagnostic methods of metabolic syndrome X and offer a simple possibility for screening of the jeopardized individuals. In a group of patients with hypertension and central obesity (group I: with 2 insulin resistant condition), 229 (89%) out of 255 cases met the basic criteria of the syndrome X which were hypertension, central obesity and high insulin levels for the corresponding blood sugar levels during oral glucose tolerance test (probable insulin resistance). Dyslipidemia was missing in 20% of these people. Hyperinsulinism occurred in 85%, glucose intolerance in 53%, presumable insulin resistance in 90% of cases. Insulin resistance was characterised by late hyperinsulinism (90 and 120 min.) during oral glucose tolerance test. This was the case in people with "diabetoid" glucose responses too, suggesting an early failure of glucose tolerance and/or insulin secretion. Components of syndrome X were present with a lower frequency in 24 patients with obesity (group II), in 35 patients with hypertension (group III) and in 29 patients without obesity or hypertension (group IV), as well. According to central obesity and hypertension, syndrome X could be screened by a probability of 90%. This can be helpful in prevention of NIDDM and coronary heart disease.
Orv Hetil 1997 Sep 21
PMID:[The value of certain parameters in the diagnosis and detection of metabolic X syndrome]. 938 Mar 79


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