Risk of type 2 diabetes mellitus and coronary heart disease: a pivotal role for metabolic factors

Prediction of the development of type 2 diabetes mellitus (T2DM) and coronary heart disease has considered a large number of factors that may have important effects on risk. Data from recent publications of the Framingham Heart Study are reviewed from the perspective of how metabolic factors contribute to increased risk for T2DM, coronary heart disease, and vascular disease. Persons with impaired fasting glucose or impaired glucose tolerance were found to have increased risk of coronary artery calcification, left ventricular hypertrophy among women, and augmented risk to develop coronary artery disease events. The metabolic syndrome risk factor burden and fasting insulin were also shown to affect the risk of developing future T2DM. Risk estimation for the development of T2DM showed that each of the five metabolic syndrome traits (increased waist girth, elevated blood pressure, low high density lipoprotein (HDL)cholesterol, high triglycerides, and impaired fasting glucose) were important predictors for the development of T2DM in middle-aged men and women. Both T2DM and coronary heart disease are consequences of persons with elevated blood glucose levels, insulin resistance, and an increasing burden of metabolic syndrome traits.