Adolescent BMI and Risk of Diabetes versus Coronary Disease

• Published in: The New England journal of medicine Vol. 364; no. 26; pp. 2558 - 2559
• Main Authors: Cure, Pablo, Cure-Cure, Carlos
• Format: Journal Article
• Language: English
• Published: United States Massachusetts Medical Society 30-06-2011
• Subjects: Adolescent; Arteriosclerosis; Body Mass Index; Cardiovascular disease; Cardiovascular diseases; Coronary artery; Coronary Disease - etiology; Coronary vessels; Cross-Sectional Studies; Diabetes; Diabetes mellitus; Diabetes mellitus (non-insulin dependent); Diabetes Mellitus, Type 2 - etiology; Diagnostic Errors; Dyslipidemia; Female; Health risk assessment; Heart diseases; Humans; Inflammation; Insulin; Insulin resistance; Metabolic syndrome; Obesity - complications; Obesity - diagnosis; Risk
• ISSN: 0028-4793; 1533-4406
• DOI: 10.1056/NEJMc1105425

To the Editor:
Tirosh et al. (April 7 issue)
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do not emphasize two crucial points. First, the metabolic syndrome is an inflammatory, prothrombotic, prehypertensive, atherogenic dyslipidemic, and prediabetic state.
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,
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Insulin resistance and excess weight are the major pathogenic mechanisms underlying the metabolic syndrome.
Second, insulin resistance increases cardiovascular risk because it induces endothelial dysfunction, and coronary artery disease is caused by, among other mechanisms, the interaction of endothelial dysfunction, atherogenic dyslipidemia, inflammation, hypertension, and multiple genes.
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This atherogenic state usually is present for decades before type 2 diabetes develops.
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So, the natural history of coronary atherosclerosis lies in the . . .