All Journals from Roby Rakhit
Metabolic syndrome (MetS) is a complex multisystem disorder, including visceral obesity, hypertension, raised fasting glucose and dyslipidaemia, which increases the risk of cardiovascular disease (CVD) and type 2 diabetes (T2DM). MetS has been defined by various organisations with the latest iteration in 2006 and has a varying worldwide prevalence (<10% to 84%). There is increasing data confirming that obstructive sleep apnoea (OSA) and non-alcoholic fatty liver disease (NAFLD) share common underlying pathological features which no doubt add complexity to this syndrome. They are also both independently associated with increased CVD. This editorial discusses recent advances in MetS with an aim to update the current definition and present the importance of a new multi-specialty integrated approach in order to improve patient care.
An obesity paradox wherein a lower incidence of cardiovascular (CV) morbidity and mortality is seen in overweight/obese patients compared with patients with a ‘normal’ body mass index (BMI) has been reported in patients with type 2 diabetes mellitus (T2DM). We evaluated the relationship between BMI and coronary atherosclerosis in a cohort of subjects with T2DM who were asymptomatic for CV disease using computed tomography coronary angiography. Subjects were followed up for a composite endpoint of all-cause death, non-fatal myocardial infarction or late coronary artery revascularisation. Of the 258 patients enrolled, 226 were eligible for follow-up over a median of 22.8 months. In patients with a normal BMI (<25 kg/m2), 53% had ≥1 significantly stenotic plaque compared with 26% of patients with a BMI >30 kg/m2 at baseline. Subjects with a BMI ≥35 kg/m2 were 82% less likely to present with significant coronary artery plaque at baseline compared with those with a BMI <25 kg/m2 (p=0.01). The risk of a composite CV endpoint event in the overweight/obese group (>25 kg/m2) was approximately 70% lower than in subjects with normal weight. In conclusion, higher BMI may be associated with a lower prevalence of coronary atherosclerosis in patients with T2DM.