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• Insulin Resistance and Cardiovascular Disease: New Perspectives From Vascular Biology


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Insulin Resistance and Cardiovascular Disease: New Perspectives From Vascular Biology

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Insulin Resistance and Cardiovascular Disease:
New Perspectives FromVascular Biology Contents Cardiovascular Disease and Insulin Resistance:Challenges and Opportunities The majority of Americans do not follow a healthy lifestyle Numbers of persons with diabetes will more than double by 2030Increasing problem of obesity and diabetes among US adults Cumulative lifetime risk for diagnosis of diabetes Over half of patients referred to cardiologists have insulin resistance syndrome Almost 70% of patients with first MI have IGT or undiagnosed diabetes Role of obesity in insulin resistance Elevated glucose increases risk in elderly patients with acute MI Insulin resistance associated with coronary vasomotor abnormalities Insulin resistance to diabetes: Coronary vasomotor abnormalities progressively worsen Insulin resistance increases risk of target organ damage in hypertension Clinical manifestations of insulin resistance

Potential role of PPAR activation in CV risk reduction

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Potential role of PPAR activation in CV risk reduction Peroxisome proliferator-activator receptors (PPARs): Overview PPAR activation and atherosclerosis: A hypothesis Focus on PPAR activation PPAR modulators PPAR modulation: Newest strategy in CV risk reduction Factors that may drive the progressive decline of -cell function TRIPOD: Evidence that insulin resistance causes -cell failure DPP: Improving insulin sensitivity/secretion prevents diabetes PPAR activation blunts progression to diabetes PPAR activation improves -cell functionCV implications of insulin resistance and PPAR activation Importance of LDL particle density Greater atherogenicity of small, dense LDL vs normal LDL Increased small, dense, LDL particles associated with reduced IHD survival PPAR activation increases LDL size and buoyancy Comparative effects of PPAR activators on lipids in diabetes CV implications of insulin resistance and PPAR activation Adipokines: An overview Adiponectin associated with decreased risk of MI Improved insulin sensitivity associated with increased adiponectin Contrasting roles of CRP and PPAR on inflammation and insulin resistance Direct relationship of CRP to metabolic syndrome Inflammation is a contributing mechanism in diabetes development PPAR activation decreases CRP in patients with diabetes CV implications of insulin resistance and PPAR activation Improved insulin sensitivity associated with reduced BP PPAR activation associated with sustained BP reduction CV implications of insulin resistance and PPAR activation PPAR activation blunts TNF-–induced PAI-1 secretion Metformin reduces PAI-1 levels in type 2 diabetes Benefits of combined insulin sensitizer therapy: Effects on CRP, PAl-1, and MMP-9

Insulin Sensitizers: Surrogate and Clinical Outcomes Studies

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Insulin Sensitizers: Surrogate and Clinical Outcomes StudiesMetformin improves endothelial function PPAR activation improves renal endothelial function and reduces proteinuria PPAR activation normalizes coronary vasomotor abnormalities in insulin resistance PPAR activation: Consistent reduction in carotid atherosclerosis PPAR activation blunts progression of carotid atherosclerosis in stable CAD PPAR activation blunts progression of carotid atherosclerosis Additive effect of statin and PPAR activation on atherosclerosis PPAR activation reduces intimal hyperplasia PPAR activation: Consistent  in neointimal proliferation (stented patients with T2D)PPAR activation reduces in-stent restenosis Preliminary data support reduction in MIwith PPAR activation PPAR activation associated with lower mortality Metformin associated with lower mortality Neutral effect of PPAR activationand metformin on hospital readmission Thiazolidinediones in patients with type 2 diabetes and HF Mortality benefit with combined insulin-sensitizing therapy Insulin sensitizers vs other glucose-lowering agents following AMI UKPDS: Risk reduction with metformin in overweight patients Evolution of clinical evidence supporting PPAR activation Anticipated results from large multicenter trials in diabetes and prediabetes PROactive: Study design PROactive: Baseline CV history PROactive: CV medications at study entry PROactive: Reduction in primary outcome PROactive: Reduction in secondary outcome PROactive: Summary DREAM DREAM: Baseline characteristics ADOPT: Study design

Identifying and Treating Patients with Insulin Resistance

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Identifying and Treating Patients with Insulin Resistance Diagnosis of diabetes, IFG, and IGT Metabolic syndrome diagnosis: ATP III emphasizes clinical practice Metabolic syndrome diagnosis: IDF emphasizes central obesity IDF ethnic- and gender-specific criteria for central obesity Metabolic syndrome diagnosis: WHO emphasizes central role of insulin resistance Other markers of insulin resistance ABCs of coronary prevention Multidisciplinary consensus on managingmetabolic syndrome DPP: Impact of  lifestyle intervention or metformin on diabetes UKPDS: Comparison of tight control of BP vs glycemia on risk of diabetes complications HPS and CARDS: Benefits of lowering LDL-C in diabetes ASCOT-LLA: Atorvastatin reduces CV events in patients with diabetes and hypertension  MICRO-HOPE, PERSUADE: Reduction in primary outcome with ACEI Steno-2 supports aggressive multifactorial intervention in type 2 diabetes Steno-2: Effects of multifactorial intervention on CV outcomes Summary
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This program was prepared and produced by Medical Education Consultants, LLCSM, Westport, Connecticut, on behalf of the University of Florida College of Medicine.

The editorial content of this program does not necessarily reflect the views or recommendations of the University of Florida College of Medicine, GlaxoSmithKline, or the publisher.
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© 2005 Medical Education Consultants, LLCSM (MEDCON). All rights reserved.

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