Therapeutic approaches to the management of dysmetabolic cardiovascular disease

Metabolic abnormalities, such as impaired insulin sensitivity, hyperinsulinaemia, dysglycaemia and dyslipidaemia, often encountered ensemble in syndrome X, are acknowledged risk factors for cardiovascular disease that may play significant roles in the accelerated development of macrovascular disease associated with insulin resistance and Type 2 diabetes. Indeed, just as tight glycaemic control has alleviated diabetic microangiopathy, there is now a possibility that targeting the proposed fundamental feature of syndrome X, insulin resistance, will play a leading part, in not only preventing Type 2 diabetes, but also in reducing the burden of both prediabetic and diabetic macrovascular disease. This may be optimally achieved with multiple risk factor interventions that improve insulin sensitivity and modify traditional and newly described dysmetabolic and pro-atherogenic factors.