Preface viiirnList of Abbreviations ixrn1 The Metabolic Syndrome: A Relevant Concept? 1rn2 Mitochondria 3rnBackground 3rnCellular respiration 6rnModulation of mitochondrial metabolic activity 9rnFactors that affect mitochondrial number and activity 10rnPeroxisome proliferator-activated receptor gamma coactivator-1 11rnMitochondrial production of prooxidant species 12rnMitochondria and nitric oxide 15rnMitochondrial calcium homeostasis 17rnThe mitochondrial permeability transition 18rnApoptosis 22rnCauses for mitochondrial dysfunction 22rnImplications of mitochondrial dysfunction 27rnMitochondrial dysfunction and cardiovascular disease 27rnMitochondrial dysfunction and metabolic disease 29rnConclusion 32rnBibliography 34rn3 Telomeres 40rnTelomere structure 40rnTelomere function 41rnTelomere shortening 41rnTelomere dysfunction 42rnPhysiologic age 42rnGender differences 43rnTelomerase 43rnCell senescence and apoptosis 46rnTelomeres in aging 49rnRisk factors for cardiometabolic disease 51rnTelomeres senescence and chronic disease 54rnCardiovascular disease 54rnInsulin resistance and type 2 DM 57rnConclusion 58rnBibliography 60rn4 The FoxO Transcription Factors and Sirtuins 64rnForkhead transcription factors 64rnFunctions of FoxO 68rnCardiovascular forkhead effects 70rnMetabolic forkhead effects 72rnHistone acetylation and deacetylation 75rnSirtuin deacetylases 76rnSirtuin regulation 78rnAntiinflammatory cardiovascular and myocyte sirtuin effects 80rnSirtuin effects on metabolism 81rnSirtuins and cell longevity 83rnForkhead deregulation and insulin resistance 85rnParadoxical effect of nutrition versus stress on cell death suppression 87rnConclusion 89rnBibliography 90rn5 Insulin and Insulin-Like Growth Factor 96rnAnabolism and catabolism 96rnControl of plasma glucose 96rnInsulin 97rnInsulin receptor location 98rnMetabolic insulin signaling 101rnInsulin-mediated glucose uptake 103rnNutrient storage and metabolism 104rnVascular and antiinflammatory effects 106rnMitogenic action 107rnInsulin-like growth factor 108rnInsulin and IGF impact on cell longevity 111rnAmylin 113rnGlucagon 113rnConclusion 113rnBibliography 114rn6 Oxidative Stress 120rnFree radicals 120rnOxidases 120rnSources for free radicals 123rnEndogenous antioxidants 124rnPhysiologic functions of oxidative stress 126rnMechanisms of oxidative damage 127rnCellular stress-sensitive pathways 127rnCellular targets of oxidative stress 128rnOxidative stress-related diseases 129rnEndothelial dysfunction with oxidative stress 129rnCardiovascular disease 130rnInsulin resistance and type 2 DM 131rnConclusion 133rnBibliography 134rn7 Mental Stress 139rnStress responses 139rnCentral stress pathways 139rnPeripheral stress pathways 140rnFight-flight-fright responses to acute stress 142rnSequelae of sustained passive stress 142rnInflammatory effects of stress pathways 143rnVascular and lipoprotein effects ofrnstress pathways 143rnStress impact on body weight 146rnMetabolic effects of stress pathways 146rnDepression and other mood disturbances 149rnConclusion 152rnBibliography 153rn8 Sleep 159rnStages of sleep 159rnCardiovascular parameters during normal sleep 160rnFunction of sleep 161rnSleep duration 164rnCircadian rhythm 165rnExamples of circadian regulation 166rnNeurohormonal modulation of wakefulness 168rnNeurohormonal modulation of sleep 170rnSleep-arousal transitions 172rnSleep deficit 174rnPathophysiologic effects of sleep debt 175rnSleep debt and risk of cardiometabolic disorder 177rnSleep disorders 179rnConclusion 182rnBibliography 183rn9 Inflammation 192rnImmune responses 192rnSelected participants in the inflammatory response 193rnC-reactive protein 198rnThe renin-angiotensin-aldosterone system and inflammation 199rnInflammation and chronic diseases 202rnInflammation endothelial and vascular dysfunction 202rnInflammation and atherosclerosis 205rnAcute inflammation carbohydrate metabolism and dyslipidemia 210rnChronic inflammation and the metabolic syndrome 213rnCauses for systemic inflammation 215rnConclusion 218rnBibliography 219rn10 Adipose Tissue and Overweight 228rnEnergy storage 228rnDiverse fat depots 230rnAdipose tissue as immune organ 234rnAdipose tissue as endocrine organ 236rnAdipokines with beneficial cardiometabolic effect 237rnAdipokines with detrimental cardiometabolic effect 244rnObesity comorbidities and cardiovascular disease 250rnObesity insulin resistance and diabetes 252rnConclusion 254rnBibliography 255rn11 Weight Loss and Diet 266rnHomeostatic responses to weight gain and weight loss 266rnAdipose weight loss effects 267rnAntiinflammatory vasculoprotective and metabolic effects of weight loss 267rnDietary intervention for weight loss 269rnCalorie restriction 270rnSurgical intervention 277rnDiet 279rnExercise as adjunct to weight loss 289rnConclusion 289rnBibliography 291rn12 Skeletal Muscle and Exercise 303rnMyocyte structure and function 303rnMetabolic adaptations in skeletal muscle 305rnEnergy sensors 311rnSkeletal muscle in inflammation 317rnSkeletal muscle in insulin resistance 318rnExercise effect on inflammation and oxidative stress 320rnExercise effect on metabolism in obesity 322rnExercise effect and cardiovascular health 322rnExercise and insulin resistance 325rnExercise and mortality 328rnExercise recommendation 331rnConclusion 332rnBibliography 334rn13 Lipids Atherogenic Dyslipidemia and Therapy 347rnApolipoproteins 347rnLipoproteins 347rnApo A-containing lipoproteins 348rnApo B-containing lipoproteins 355rnApolipoproteins C D and E 360rnThe triglyceride lipase family 360rnThe normal metabolism of free fatty acids 363rnInflammation and hepatic insulin resistance 365rnAtherogenic dyslipidemia in insulin resistance 369rnLipid-lowering therapy 372rnThe HMG CoA reductase inhibitors 374rnNicotinic acid 387rnThe fibric acid derivatives 388rnBile acid sequestrants 391rnEzetimibe 391rnCETP inhibition 391rnConclusion 392rnBibliography 393rn14 The Endothelium Cardiovascular Disease and Therapy 409rnEndothelial function 409rnNitric oxide synthase and eNOS 409rnEndothelial NO synthesis 410rnSpecific enhancers of NO synthesis 413rnFunctions of nitric oxide 415rnShear stress and vascular function 418rnMechanisms of endothelial dysfunction 420rnInsulin insulin resistance and endothelial dysfunction 424rnImplications of endothelial dysfunction 428rnAssessment of endothelial function 430rnHypertension 432rnCardiomyopathy 434rnCoronary and peripheral vascular disease 440rnPharmacologic antagonism of the renin-angiotensin-aldosterone system and endothelin-1 443rnBeta-adrenergic blockade 448rnPhosphodiesterase-5 inhibitors 449rnConclusion 450rnBibliography 451rn15 Insulin Resistance Metabolic Syndrome and Therapy 468rnDiagnostic criteria for the metabolic syndrome 468rnPrevalence of the metabolic syndrome 470rnInsulin resistance 470rnCauses of insulin resistance 474rnPathways toward insulin resistance 476rnPharmacologic therapy to improve insulin sensitivity 480rnConclusion 483rnBibliography 484rnIndex 491
Trends indicate that the metabolic syndrome will become the leading risk factor for heart disease. Now more than ever you need an all-in-one reference that provides the tools and practical advice you need to:n* Identify at-risk patientsn* Explain individual contributing factorsn* Aid in patient education and motivationn* Direct comprehensive care andn* Choose the most appropriate interventionsrnComprehensively revised to reflect leading-edge research and now organized to facilitate easy access to essential information and clinically-relevant guidance, Metabolic Syndrome and Cardiovascular Disease, 2e offers this and more. Not only will you receive a solid understanding of the pathophysiology underlying the metabolic syndrome and cardiovascular disease but also the rationale for today's most effective treatments.rnWhat's new?rnFilled with timely new content, this updated edition covers:n* New discoveries that have changed our understanding of the pathogenesis and interrelationship of metabolic syndrome, cardiovascular disease (CHD), and type 2 diabetes mellitus (DM)n* The relevance of mitochondria and telomeresn* Sleep and its impact on cardiometabolic healthn* The pivotal interplay between insulin and forkhead transcriptionfactorsn* Calorie restriction researchn* Bariatric surgery experiences and outcomesrnIn addition, each chapter includes essential information on comorbidities, interventions, and pharmacotherapeutic options - an exclusive feature found only in the second edition!