This volume contains the papers presented at "The 8th European Symposium on Metabolism". It provides a comprehensive and updated evaluation of the possible role of insulin resistance in the pathogenesis of a cluster of major risk factors for cardiovascular disease. Insulin resistance was recognized as a feature and a pathogenetic mechanism in pathological states such as type 2 diabetes mellitus and obesity. More recently, however, it has become apparent that impairment in insulin action may be shared by a variety of conditions, not necessarily associated with diabetes or obesity such as hypertension and endothelial dysfunction. It leads not only to metabolic but also to hemodynamic alterations and to proinflammatory reactions. Therefore, The Metabolic Syndrome is a disorder in which not only the "response to injury" concept is operative, but also the substrate alterations and the pathophysiology of the arterial wall are strictly interconnected in a complex web of reactions, leading to atherosclerotic plaques. This volume represents a comprehensive review of genetics, epidemiology, physiolopathology, cardiovascular complications and therapy of insulin resistance.
Preface. Opening lecture. The metabolic syndrome revisited (P.J. Lefebvre). Epidemiology. Prevalence, ancillary clinical features and cardiovascular disease in the metabolic syndrome: the Bruneck study (E. Bonora et al.). HbA1c as a diagnostic tool for diabetes (B. Balkau et al.). The athero-thrombotic and inflammatory profile of visceral obesity (J.-P. Despres). Genetics. The genetics of adiponectin (F. Vasseur). Genetic variants of modulators of insulin action (V. Tassi et al.). Candidate genes for insulin resistance: what's new? (M. Laakso, A. Kubaszek). Adipokine genes and the insulin-resistance syndrome (A. Doria). Autosomal recessive hypercholesterolemia: genetics and clinical aspects (G. Zuliani, R. Fellin). APOA5 - a recent addition to genes determining plasma triglycerides (P.J. Talmud). Molecular-genetics of the hypoalphalipoproteinemias in Italy (S. Bertolini et al.). Beta cell function. Type 2 diabetes: simple, dual or multiple pathogenetic defects? (S. Del Prato, A. Coppelli, P. Marchetti). Signals adapting the beta cells to changes in insulin sensitivity (B. Ahren, G. Pacini). Glucotoxicity and lipotoxicity in the beta cell (A. M. Rabuazzo et al.). Arterial wall function. Diabetes mellitus, oxidative stress and endothelial dysfunction (K.Sydow, T.Munzel). Nonesterified fatty acids and endothelial dysfunction (A. Avogaro et al.). Renal complications. Diabetic nephropathy - an acquired or inherited disease? (P.-H. Groop, C.Forsblom). Diabetic nephropathy: renal structural studies in type 1 and type 2 diabetic patients (M. Dalla Vestra, P. Fioretto). Pathogenetic mechanisms of diabetic microangiopathy (U. Di Mario, G. Pugliese). Diabetic nephropathy - the diabetologist's dream is currently a nightmare (P. Passa). Cardiovascular complications. Vascular effects of insulin - A clinical physiologist's viewpoint (R.C. Bonadonna). Insulin resistance and impaired regulation of hemodynamic parameters (P. Valensi). Renin-angiotensin system and endothelial function (R. Ceravolo et al.). Dyslipidemia of the plurimetabolic syndrome and risk of cerebrovascular events (N. Vitturi et al.). From cholesterol to risk analysis: the revolution of the Heart Protection Study (G.F. Gensini, B. Dilaghi). The plurimetabolic syndrome: qualitative lipoprotein abnormalities and atherosclerosis (A. Zambon, G.Crepaldi). Prevention and treatment. Lifestyle modification to prevent type 2 diabetes (G. Riccardi, R. Giacco, M. Parillo). Dietary therapy of the metabolic syndrome (R. Carmena). Statins and the metabolic syndrome (M. Averna, A. Lo Verde). Effects of statins on lipoprotein fractions (C. Cortese, L. Liberatoscioli). Results of the Heart Protection Study: can we still assume a class effect? (A. Corsini, F. Bernini). Sulfonylureas in the prevention of vascular complications: from UKPDS to the ADVANCE study (A.J. Krentz). KATP channel pharmacology in the pancreas and the cardiovascular system (F.M. Gribble, F. Reimann). Reduction of visceral fat and improvement of metabolic and respiratory complications in severe obesity (G. Enzi, L. Busetto). Blood glucose in relation to blood pressure control as risk factors in the progression of renal damage in type 2 diabetes (R. Nosadini). Author index. Keyword index.
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