Operative risk factors in the metabolic syndrome: is it lipids and high blood pressure or are there direct vascular effects of insulin resistance and obesity?

The metabolic syndrome is associated with an increased risk for cardiovascular disease. Dyslipidemia, high blood pressure, and impaired glucose tolerance, components of the metabolic syndrome, are all clearly atherogenic. Insulin resistance is an important correlate of other risk factors. Excess abdominal fat, as often seen in overweight people and commonly observed in obese individuals, is the single most important central feature of the metabolic syndrome. In addition to insulin resistance, an excess amount of abdominal fat is associated with all the features of metabolic clustering. Adipocytes secrete several peptide hormones that have been related to the metabolic syndrome and related cardiovascular disease. The role of traditional versus novel adipose tissue-related risk factors in the background of atherosclerosis in the metabolic syndrome are discussed.