Diabetes and cardiovascular disease

Diabetes and cardiovascular disease

Diabetes and cardiovascular disease have emerged as major threats to
human health, and the risk of developing these chronic conditions is
increased in individuals with abdominal obesity and the metabolic
syndrome. Excess visceral abdominal tissue (VAT) accumulation appears
to be a key feature of abdominal obesity contributing to the
development of the metabolic syndrome. For instance, excess VAT is
accompanied by elevated triglycerides, reduced high-density
lipoprotein (HDL) cholesterol, elevated blood pressure, and/or
elevated fasting plasma glucose. In addition, the rather normal or
only marginally elevated low-density lipoprotein (LDL) cholesterol
concentrations in patients with excess VAT could provide misleading
information as viscerally obese patients have an increased plasma
concentration of small, dense LDL particles. Prospective studies have
suggested that even among patients with LDL cholesterol concentrations
within normal limits, an increased concentration of small LDL
particles is associated with higher risk of cardiovascular disease.
With the treatment of abdominal obesity and excess VAT, an increase in
patients' LDL particle size and improvements in other cardiovascular
risk factors (eg, insulin levels, glucose tolerance, HDL, C-reactive
protein [CRP], and adiponectin levels) can be achieved. Waist
circumference can be used in clinical practice as a first approach and
as a crude index to identify patients who have excess VAT,
particularly when the elevated waistline is accompanied by the
clinical features of the metabolic syndrome, among which an elevated
fasting triglyceride concentration appears to be predictive of a
reduced LDL particle size and of further metabolic abnormalities
frequently referred to as the metabolic syndrome."