Speaker Abstract

The Insulin Resistance Syndrome of Abdominal Obesity: Clinical and Public Health Implications Beyond the Prevention of Type 2 Diabetes

J.-P. Després, Ph.D., Québec Heart Institute and Lipid Research Center, CHUL Research Center, Sainte-Foy, CANADA.

Complications such as hypertension, type 2 diabetes and cardiovascular diseases are more prevalent in obese patients than in normal weight individuals. Studies published over the last 15 years have emphasized the role of abdominal visceral adipose tissue accumulation as a critical correlate of metabolic abnormalities that have been in the past associated with excess fatness per se. Thus, excess visceral adipose tissue accumulation, which can be assessed by imaging techniques such as computed tomography, has been associated with hyperinsulinemia, insulin resistance, glucose intolerance which may evolve to type 2 diabetes, hypertriglyceridemia, elevated LDL particle concentration, increased proportion of small-dense LDL particles and reduced plasma HDL cholesterol concentrations. This cluster of metabolic abnormalities is associated with a substantial increase in the risk of ischemic heart disease (IHD). As most visceral obese patients have rather "normal" LDL-cholesterol levels, it is suggested that IHD risk in these individuals should be assessed, in addition to conventional risk variables, by a triad of metabolic abnormalities which include hyperinsulinemia, hyperapo B and small-dense LDL particles. These atherogenic metabolic complications are even found among individuals who may never develop type 2 diabetes, suggesting that the time for "preventive endocrinology" may have come.