| Slide Lecture Programs |
| 2006 Core Curriculum |
| Targeting Insulin Resistance for Vascular Protection |
July 31, 2006
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Targeting Insulin Resistance for Vascular Protection" width="220" height="147" border="0">
Targeting Insulin Resistance for Vascular Protection
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Vascular Consequences of Diabetes and Insulin Resistance
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One third of adults with diabetes are
undiagnosed
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Rising prevalence of diabetes
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Parallel epidemics of diabetes and obesity
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90% of patients with newly-diagnosed diabetes are overweight or obese
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IFG/IGT: Challenge for prevention
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DECODE: IGT increases mortality risk
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CHD risk appears to begin at low blood glucose levels
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Continuum of CV risk: Reason for early intervention in patients with IFG/IGT
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Even mild glucose elevations increase mortality in patients undergoing PCI
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IGT and undiagnosed DM2 are common in acute MI and stroke
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Risk of endothelial dysfunction increases at FG 110-125 mg/dL
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Impaired macrovascular reactivity in people at risk for type 2 diabetes
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Insulin resistance: Risk factor for CV disease
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Insulin resistance and atherosclerosis
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Who has insulin resistance?
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Insulin resistance is an independent predictor of HF
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Insulin resistance increases risk of chronic kidney disease (CKD)
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Development of insulin resistance in obesity-induced inflammation and stress
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Visceral fat independently predicts mortality
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CRP levels show positive correlation with visceral obesity
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Shared CV risk between insulin resistance and visceral obesity
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Metabolically active molecules link obesity and atherosclerosis
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Antiatherogenic effects of adiponectin
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Visceral obesity and adiponectin
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Inverse relationship between baseline adiponectin level and MI risk
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Shared metabolic abnormalities with insulin resistance and endothelial dysfunction
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PPAR activation and atherosclerosis: A hypothesis
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Peroxisome proliferator-activator receptors (PPARs)
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Beyond fat and glucose: Potential for CV benefits with PPAR-gamma agonists
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Obesity induces inflammatory changes in adipose tissue
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Macrophage and adipocyte similarities
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PPAR signaling pathways influence macrophage gene expression and
foam-cell formation
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PPAR-gamma agonists improve endothelial vasodilation and decrease inflammation
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PPAR-gamma agonists impact inflammatory markers and adiponectin
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Added benefit of BP reduction with PPAR-gamma agonists
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PPAR-gamma agonists increase collagen content-potentially improving plaque stability
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Potential vascular benefits of PPAR activation
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