The Framingham Offspring Study
نویسنده
چکیده
TYPE 2 DIABETES MELLITUS AND ITS precursor, impaired glucose tolerance (IGT), are associated with increased risk for morbidity and mortality from cardiovascular disease (CVD), particularly coronary heart disease. An increased prevalence of traditional risk factors for atherosclerosis (eg, hypertension, low high-density lipoprotein cholesterol [HDL-C] levels) occurs in type 2 diabetes and IGT, but these factors account for only half of the observed excess risk for CVD. Novel CVD risk factors, including insulin resistanceandhyperinsulinemia,havebeen proposed to account for excess CVD risk in glucose intolerance. However, the role of hyperinsulinemia as an independent risk factor for CVD remains uncertain; its apparent effect could be due to other factors rather than to the direct toxicity of insulin itself. The emerging role of acute thrombosis in the etiology of CVD suggests additional novel risk factors that could mediate risk associated with hyperinsulinemia. Biochemical markers of hypercoagulability, including elevated Author Affiliations and Financial Disclosures are listed at the end of this article. Corresponding Author and Reprints: James B. Meigs, MD, MPH, General Internal Medicine Unit S50-9, Massachusetts General Hospital, Boston, MA 02114 (e-mail: [email protected]). Context Increased risk for cardiovascular disease in persons with glucose intolerance (impaired glucose tolerance and type 2 diabetes mellitus) is not fully explained by concomitant elevations in traditional atherosclerosis risk factors. Hyperinsulinemia associated with glucose intolerance may increase risk directly, or its effect could be mediated through impaired hemostatic function.
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