Cardiometabolic risk: a Framingham perspective

Objective: To review published data on vascular disease- and diabetes-related outcomes related to adiposity and metabolic risk factors. Design: Community cohort study with cross-sectional and prospective data. Subjects: Middle-aged Caucasian adults in a suburban environment. Measurements: Traditional risk factors for cardiovascular disease and the type 2 diabetes mellitus, as well as measures of insulin resistance, left ventricular hypertrophy and vascular calcification. Results: The cardiometabolic risk factors cluster in the population and a common core that includes adiposity (both waist and body mass index), abnormal lipids (both HDL cholesterol and triglycerides), and abnormal glucose and insulin metabolism was found to be present in Framingham participants. Increased insulin resistance was also found to be associated with coronary artery calcification and left ventricular hypertrophy in women. Analyses of the metabolic syndrome risk factors showed that a greater burden of risk factors was associated with greater risk of both cardiovascular disease and diabetes mellitus. An equation to estimate risk of developing type 2 diabetes mellitus has been developed from the Framingham experience, and the risk factors included in the metabolic syndrome are key components, including increased waist girth, elevated blood pressure, low HDL cholesterol, high triglycerides and impaired fasting glucose. Conclusion: Cardiometabolic factors and insulin resistance are important contributors to the development of type 2 diabetes mellitus, subclinical cardiovascular disease and clinical cardiovascular disease.