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PubMedDate not supplied

Analysis of foodborne disease in Belgium in 1997.

Foodborne disease represents a major problem for public health in industrialized countries, albeit with a low lethality. Foodborne diseases are defined as a group of viral, bacterial or parasitic gastrointestinal infections transmitted by means of food. Proper food-hygiene practices and surveillance of individual diseases and in particular outbreaks are the first steps in targeting their prevention. The incidence of this illness is difficult to estimate. In the Netherlands a yearly incidence of gastrointestinal infections of 500 per 1,000 inhabitants is estimated, of which most are foodborne. To set up priorities in the actions to undertake, to establish the most frequent risks, to develop preventive efforts and to answer to international requirements, accurate data on foodborne disease from Belgium are required. In order to co-ordinate the initiatives in the Belgian context, a working group was set up in 1995. In 1997 a total of 2,013 persons with foodborne disease were identified as part of 140 outbreaks, 22 of which occurred with 10 cases or more. Salmonella Enteritidis (88 outbreaks) was identified as the main pathogen in foodborne disease, followed by S. Typhimurium (11), S. Hadar (4). Eggs and meat products were identified as the main food-items involved, although it remains difficult to obtain proper intervention studies allowing to identify the specific cause(s). In 1997, a total of 12,732 human Salmonella isolates and 5,617 Campylobacter isolates were identified by the respective national reference laboratories. Salmonella isolates from Belgium accounted in 1997 for more than a fifth of all Salmonella isolates in the EU. The final objective of the working group is the implementation of a surveillance system for all risk factors concerned with the development of food-related illness, including an early warning system and an efficient analysis of microbiological criteria relating to human health, food and food production, including livestock. An essential element of this surveillance is communication of the results, risks and measures for prevention between all the departments, institutions and public health authorities concerned.

Bacterial Infections↗

PubMed1990

Genetic approaches in the study of periodontal diseases.

Periodontal diseases are essentially infectious in origin, their outcome depending on interaction between the pathogenic challenge and host response. Host genotype has been implicated in certain of the more unusual forms, but together these account for only a small proportion of periodontal patients. Nevertheless, the genes for these rarer conditions, some of which have already been located and/or cloned, are of considerable importance, since they may ultimately provide clues leading to a better understanding of the whole spectrum of periodontal disease. For the majority of periodontal patients, although inherited susceptibility is suspected, evidence of a significant genetic component is scanty. The priority here is therefore to establish the existence of contributing genes. This may be possible by using approaches designed to minimise the confounding effect of environmental variation that has probably been a source of confusion in the past.

Genes↗

PubMed2000

From breast to baby: quality assurance for breast milk management.

Breast milk is a body fluid capable of transmitting blood-borne pathogens when ingested. High-risk infants are frequently fed mother's expressed breast milk and may be at risk if they receive the wrong mother's milk. A multidisciplinary team at this 42-bed Level III regional NICU developed a quality assurance program and audit aimed at reducing the risk of feeding expressed breast milk (EBM) to the wrong high-risk infant in the unit. Changes to the old system included modernizing the handling, storing, and distribution of EBM. Elimination of feeding errors was the priority. A specific protocol to minimize EBM feeding errors became part of the quality assurance program and is consistent with the recommendations of the NICU multidisciplinary team.

Breast Feeding↗

PubMed1994

Bacterial infections in HIV-infected patients.

Although the original opportunistic pathogens described in AIDS were protozoal and fungal organisms, bacterial infections are now recognized with increased prevalence and altered expression in patients with HIV infection. Especially since populations outside of North America and populations of i.v. drug abusers have been studied, bacterial infections have been shown to cause substantially increased morbidity and mortality both early and late in the course of HIV infection. Just as strategies have been developed for primary and secondary prophylaxis of classical HIV-related opportunistic infections, prevention of bacterial complications should be a high priority. Good hygiene and avoidance of unsterile needles in illicit drug use, tattooing, ear-piercing, or other cosmetic or ritual activities should be emphasized in patient education. Patients should be counseled to avoid uncooked or poorly cooked eggs and poultry and to avoid unpasteurized milk products. Pneumococcal vaccine is recommended for all HIV-seropositive patients and should be given as early as possible after recognition of HIV infection for maximal efficacy. Influenza vaccine is also recommended. It may have a role in preventing bacterial pneumonia secondary to influenza. Patient management should include regular dental care and nutritional evaluation. The use of intravenous or central catheters should be limited to essential therapies. When patients present with new febrile illness, a high index of suspicion for invasive bacterial disease is appropriate. The signs of serious bacterial infection in HIV-positive patients are subtle. Diagnostic evaluation should include cultures of blood and other relevant clinical specimens. Empiric antimicrobial therapy based on the clinical presentation may be life saving in patients with invasive bacterial disease complicating HIV infection.

AIDS-Related Opportunistic Infections↗

PubMedDate not supplied

Diagnosis of tuberculosis and other diseases caused by mycobacteria.

The adequate diagnosis and treatment of tuberculosis depends on many events, including rapid pathogen detection, patient isolation, species identification, and drug susceptibility testing. Well trained staff, using state-of-the-art technology, are necessary in the mycobacteriology laboratory to produce timely results that are necessary for the patients' care and public health measures. Mycobacteriology laboratories still play a pivotal role in the control of tuberculosis, which is especially true in view of the spread of multidrug-resistant tuberculosis. One way to optimize diagnostic efforts in spite of limited financial resources might be to sort and allocate specimens according to a system of priorities, e.g., diagnostic versus follow-up specimens. A "fast track" program for tuberculosis testing, which should be established as part of a dynamic diagnostic network, should focus on the highly infectious patient population. Collaboration between clinicians and mycobacteriologists remains the basis of dynamic diagnostic teamwork. Immediate screening of smears for acid-fast-bacilli in patients suspected of tuberculosis, followed by immediate processing of smear-positive specimens using modern mycobacteriological technology, should be given high priority. Diagnosis of disease due to nontuberculous mycobacteria can be difficult. Nontuberculous mycobacteria are commonly found in nature, and assessment as to whether a nontuberculous mycobacterium isolate is clinically significant can be a difficult task.

Humans↗

PubMed1999

EU conference 'The Microbial Threat'.

A global or European strategy should be developed to deal with increasing antimicrobial resistance. This strategy includes surveillance of antimicrobial resistance and monitoring of the use of antimicrobial agents in animals and humans. In animals, surveillance should be focussed on potential transfer of resistant, zoonotic, food-born pathogens and resistance genes to humans. In humans the surveillance should be clinically relevant. Guidelines for rational therapy should be implemented and 'antibiotic teams' should be installed in each hospital to evaluate the prescription of antibiotics and its compliance with guidelines. Keeping animals for food production involves the responsibility for their well being. This includes treatment of infections. However, the use of feed additive, growth-promoting antimicrobials related to therapeutics in human medicine, should be banned immediately. Research aimed at intervention strategies for antimicrobial resistance should be given a high priority with adequate financing both nationally and in Europe. Well co-ordinated European research programmes should have priority; this includes the need to install a European multidisciplinary scientific advisory group.

Animals↗

PubMed2001

Apomictic, polyphagous root-knot nematodes: exceptionally successful and damaging biotrophic root pathogens.

Most apomictic root-knot nematodes (RKN; Meloidogyne spp.) have host ranges that encompass the majority of flowering plants, and M. incognita is possibly the world's most damaging crop pathogen. The ancestors, age, and origins of the polyphagous RKN are obscure, but there is increasing evidence that M. incognita, M. javanica, and M. arenaria are closely related, heterogeneous species with a recent, hybrid (reticulate) origin. If so, they must owe much of their current worldwide distributions to spread by agriculture. Host resistance appears to be generally durable in the field, but laboratory studies suggest that apomixis does not prevent evolution in response to selection by a parasitic bacterium (Pasteuria penetrans) and host resistance. Maintaining general fitness may be the evolutionary priority for most populations of polyphagous RKN, and a wide host range, important in the field but not in the laboratory, may be conserved by apomixis. Several factors may help confer a wide host range, including suppression of host resistance, perhaps as a consequence of the strength of the induced susceptible response. Resistance genes effective against RKN appear not to have resulted from coevolution. Rates of juvenile invasion and/or development are low in many wild and some crop plants, with the result that they are both poor hosts and sustain less damage. Overall, it is suggested that greater coordination, particularly of fundamental research, is required.

Animals↗

PubMed2006

Pathogen indicator microbes and heavy metals in Lake Pontchartrain following Hurricane Katrina.

Storm surge and several breaches of the New Orleans, Louisiana levee system caused flooding of more than 80% of the city following Hurricane Katrina in August 2005. Most of the floodwaters pumped out of the city were discharged to Lake Pontchartrain. Lake water and sediment samples were collected during September 19 to October 9, 2005 to determine the possible impact of the dewatering operation on Lake Pontchartrain. Surface water E. coli and enterococcus counts were high at stations near the mouth of the 17th Street Canal (geometric means = 6.0 x 10(3) CFU/100 mL and 1.7 x 10(2) CFU/100 mL, respectively) but decreased by factors of 40 and 5, respectively, at stations 5 km from the mouth of the canal. Priority heavy metal concentrations were generally undetectable or below U.S. EPA criterion maximum and criterion continuous concentrations. Surface sediments near the mouth of the canal contained generally higher concentrations of enterococcus, E. coli, and Al-normalized metals than points further from the canal. The impact of the discharged floodwaters on heavy metal concentrations and indicator organism counts in the water column of Lake Pontchartrain appears to have been small and short-lived. Historically, however, the canal has been a significant contributor of pollutants to the sediments.

Arsenic↗

PubMed2004

Review of the trematode genus Ribeiroia (Psilostomidae): ecology, life history and pathogenesis with special emphasis on the amphibian malformation problem.

Trematodes in the genus Ribeiroia have an indirect life cycle involving planorbid snails as first intermediate hosts, fishes or amphibians as second intermediate hosts and birds or mammals as definitive hosts. Although rarely pathogenic in definitive hosts, Ribeiroia infection can cause severe pathology and mortality in snails and amphibians. This group of parasites has gained notoriety for its prominent rol in the recent rash of amphibian deformities in North America. Under some circumstances, these malformations may enhance parasite transmission by rendering infected amphibian hosts more susceptible to definitive host predators. However, increasing reports of malformations in North American amphibian populations emphasize the importance of understanding infection patterns. Here we review important aspects of the biology, ecology, life cycle and pathogenesis of parasites in the genus Ribeiroia and identify priorities for future research. Based on available morphological descriptions and preliminary molecular data, three species of Ribeiroia are recognized: R. ondatrae in the Americas, R. marini in the Caribbean and R. congolensis/C. lileta in Africa. We further evaluate the influence of abiotic and biotic factors in determining the intensity and prevalence of Ribeiroia infection and malformations in amphibians, highlighting the importance of habitat alteration and secondary factors (e.g. aquatic eutrophication, contaminants) in promoting infection. Although not a "new" parasite, Ribeiroia may have increased in range, prevalence, or intensity in recent years, particularly within amphibian hosts. Nevertheless, while much is known about this intriguing group of parasites, there remains much that we do not know. Particular importance for future research is placed on the following areas: evaluating the phylogenetic position of the genus, establishing the molecular mechanism of parasite-induced malformations in amphibians, isolating the drivers of parasite transmission under field conditions and studying the consequences of malformations for parasite and host populations. Investigation of these questions will benefit enormously from a multidisciplinary approach that effectively integrates parasitology, developmental biology, immunology, herpetology and aquatic ecology.

Amphibians↗

PubMed2004

Systematic reappraisal of Coniella and Pilidiella, with specific reference to species occurring on Eucalyptus and Vitis in South Africa.

The genus Pilidiella, including its teleomorphs in Schizoparme, has a cosmopolitan distribution and is associated with disease symptoms on many plants. In the past, conidial pigmentation has been used as a character to separate Pilidiella (hyaline to pale brown conidia) from Coniella (dark brown conidia). In recent years, however, the two genera have been regarded as synonymous, the older name Coniella having priority. To address the generic question, sequences of the internal transcribed spacer region (ITS1, ITS2), 5.8S gene, large subunit (LSU) and elongation factor 1-alpha gene (EF 1-alpha) were analysed to compare the type species of Pilidiella and Coniella. All three gene regions supported the separation of Coniella from Pilidiella, with the majority of taxa residing in Pilidiella. Pilidiella is characterised by having species with hyaline to pale brown conidia (avg. length:width > 1.5), in contrast to the dark brown conidia of Coniella (avg. length:width < or = 1.5). Pilidiella diplodiella, which is a pathogen associated with white rot of grapevines, was shown to be an older name for C. petrakii. To delineate species in the P. diplodiella species complex, isolates were also compared based on histone (H3) gene sequences. Analyses derived from these sequence data separated P. diplodiella from a newly described species, P. diplodiopsis. The new species P. eucalyptorum sp. nov. is proposed for isolates formerly treated as C. fragariae and associated with leaf spots of Eucalyptus spp. This species clustered basal to Pilidiella, and may represent yet a third genus within this complex. Pilidiella destruens sp. nov. is newly described as anamorph of Schizoparme destruens, which is associated with twig dieback of Eucalyptus spp. in Hawaii. A key based on morphological characteristics is provided to separate the taxa treated in this study.

Ascomycota↗

PubMed1996

[Motor neuron diseases. Present].

Recent progress in our understanding of motor neuron diseases, particularly those of degenerative pathogenesis such as spinal muscular atrophies (SMA) and amyotrophic lateral sclerosis (ALS), have to be described as historic. They are essentially of three types: 1) In first place are advances afforded by molecular genetics both in SMA (with the discovery of survival motor neurons and neuronal apoptosis inhibitor protein, which are markers of the disease and their pathogenetic mechanism) and in ALS (with the discovery of the super oxide dismutase [SOD1] gene, involved in the genesis of familial forms of ALS and other types of SMA such as certain forms of familial juvenile ALS, bulbar-spinal atrophy with gynecomasty and others). 2) In second place are biological data detailing the mechanisms of neuron death, whether programed or not, and emphasizing the importance of the so-called trophic or neurotrophin factors-whether nerve growth factor, brain-derived-neurotrophic factor, neurotrophin-3 or others whose effect of preventing neuron death has been demonstrated in vitro-as well as that of other substances such as Ca(2+)-activated neutral protease, which stabilizes synapses during development. It is assumed that one or another of these data will lead to therapeutic strategies for blocking the cascade of events that lead to neuron degeneration. 3) Finally, the strong impact of neuroimmunology in the field of neuromuscular pathology has been of interest mainly in neurogenic diseases marked purely and essentially be motor expression. As markers and pathogens, antiganglioside antibodies must necessarily be determined at this time in such entities as multifocal motor neuropathy, Guillain-Barré syndrome, acute axon motor neuropathy, Miller-Fisher syndrome and others, as their presence can inform therapeutic approaches. These three aspects and others currently under discussion will be treated in this course. At the same time the basic diagnostic aspects of motor neuron diseases will be emphasized: electrophysiologic assessment, on the one hand, and clinical features on the other. Establishing an exhaustive classification of SMA, from the earliest forms of infancy to adult types, is of great priority, as is exposing the full range of SMA according to whether distal or proximal predominance of atrophy is present. Our current understanding of the field is summarized in ten chapters on degenerative motor neuron diseases.

Amyotrophic Lateral Sclerosis↗

PubMed2006

High frequency of SDHB germline mutations in patients with malignant catecholamine-producing paragangliomas: implications for genetic testing.

CONTEXT: Adrenal and extraadrenal paragangliomas are tumors of chromaffin cells that are usually benign but that may also develop into malignant disease. Mutations of the gene for succinate dehydrogenase subunit B (SDHB) are associated with a high risk of malignancy, but establishing the precise contribution requires relatively large numbers of patients with well-defined malignancy. OBJECTIVE: We assessed the prevalence of SDHB mutations in a series of patients with malignant paraganglioma. DESIGN: SDHB mutation testing was carried out in 44 consecutive patients with malignant paraganglioma. Clinical characteristics of patients with malignant disease due to SDHB mutations were compared with those without mutations. RESULTS: Pathogenic SDHB mutations were found in 13 of the 44 patients (30%). Close to one third of patients had metastases originating from an adrenal primary tumor, compared with a little over two thirds from an extraadrenal tumor. Among the latter patients, the frequency of SDHB mutations was 48%. CONCLUSION: This study establishes that missense, nonsense, frameshift, and splice site mutations of the SDHB gene are associated with about half of all malignancies originating from extraadrenal paragangliomas. The high frequency of SDHB germline mutations among patients with malignant disease, particularly when originating from an extraadrenal paraganglioma, may justify a high priority for SDHB germline mutation testing in these patients.

Abdominal Neoplasms↗

PubMed2000

[A comparative study of antibacterial activity of ceftibuten, ceftazidime, cefuroxime and ampicillin against clinical isolates].

Ceftibuten is an orally active third generation new cephalosporin. Its antibacterial activity in vitro was tested to many clinical isolates and was compared to the activity of ceftazidime, cefuroxime and ampicillin, by twofold serial dilution method in Müller-Hinton agar--detection of minimum inhibitory concentrations (MIC) and by the disc-diffusion method of Kirby-Bauer. The new cephalosporin demonstrated great activity against the different clinical important strains. Many resistant strains to ampicillin were high susceptible to ceftibuten. The majority of Gram-negative organisms, including Enterobacteriaceae, the respiratory pathogens M.(B.) catarrhalis and H. influenzae are highly susceptible to Ceftibuten, however Pseudomonas, Acinetobacter are resistant. The majority of methicillin-susceptible strains of Staphylococcus are resistant too. New cephallosporin was also active against S. pyogenes (Streptococcus gr. A) and penicillin-susceptible pneumococci, but was inactive against S. agalactiae (Streptococcus gr. B), S. pneumoniae penicillin-resistant strains and enterococci, similar to the other cephalosporins. The activity of ceftibuten was higher than that of ampicillin and cefuroxime against beta-lactamases positive strains of H. influenzae and M.(B) catarrhalis, also against tested strains of Enterobacteriaceae. The major priority of the new antibacterial agent over other cephalosporins and ampicillin is its stability to hydrolysis by the main broad-spectrum beta-lactamases producing E. coli and K. pneumoniae sp.

Ampicillin↗

PubMed2005

Synbiotics and the mucosal barrier in critically ill patients.

PURPOSE OF REVIEW: Outcome in severe and critical illnesses is strongly related to premorbid conditions: the strength of the mucosal barriers, the innate immune system, and the built-in resistance to disease. Early risk factors and determinants of poor outcome are factors such advanced age; impaired premorbid health status, especially diabetes and high body mass index (obesity); and immunosuppressive treatments. Combined supplementation of bioactive fibers and lactic acid bacteria (synbiotics) directly and indirectly influences several of these factors. RECENT FINDINGS: Determinants for poor outcome are degree of oxidative stress, neutrophil activation, and infiltration of tissues, especially in the lungs. Attempts at early reduction of the exaggerated inflammatory storm and limitation of further impairment of the immune function are always given the highest priority. The supply of live lactic acid bacteria and plant fibers can dramatically reduce the hyperinflammation and also the infiltration by neutrophils of organs such as the lungs. New and efficient autopositioning and regurgitation-resistant feeding tubes provide instruments for the early supply of enteral nutrition with immune-boosting antioxidants and synbiotics. SUMMARY: A meticulous choice of probiotic lactic acid bacteria is recommended because only a small minority of the lactic acid bacteria survive the harsh environment of the upper gastrointestinal tract, ferment strong semiresistant fibers such as inulin, and have the ability to control inflammation and eliminate unwanted pathogens, such as antibiotic-resistant microorganisms and Clostridium difficile.

Critical Illness↗

PubMed1986

Periodontal health and disease in young people: screening for priority care.

Gingivitis is the most common chronic disease affecting young people. Almost all teenagers exhibit gingival lesions in the interproximal areas of posterior teeth. Gingivitis is caused by supragingival bacterial plaque which contains more than 165 species and subspecies. No single organism or group of bacteria can be directly implicated in the development of gingivitis. Periodontitis occurs before 20 years of age, is also first found in the interdental areas of posterior teeth and is preceded by gingivitis. It progresses slowly through the decades of adult life with varying rates in different individuals and teeth within the same mouth. Subgingival plaque contains more gram-negative, anaerobic organisms and more motile bacteria than supragingival plaque. Progression of periodontitis coincides with the occurrence of certain Bacteroides species, fusobacteria and other anaerobic motile rods as well as spirochetes. However, at this time the concept of specific pathogenicity cannot be applied. Rapidly progressing localized or generalized periodontitis is characterized by the rate of periodontal destruction and usually occurs in less than one per cent of juveniles. These patients exhibit increased prevalence of Actinobacillus actinomycetemcomitans and abnormalities in neutrophil function. At present, simple clinical screening tests that can predict who will and who will not suffer from chronic periodontitis, that can provide early identification of high risk patients or forewarn the development of juvenile periodontitis are non-existent. Research in this area is seeing significant progress and several technologies have shown promise. While awaiting new screening methodologies, the clinician must continue to rely on periodontal probing, radiographic techniques, visual inspection and clinical acumen as the main means of periodontal diagnosis.

Adolescent↗

PubMedDate not supplied

[Mémantine (Ebixa): a new therapeutic strategy for the treatment of moderate to severe forms of Alzheimer's disease].

Alzheimer's disease has definitively emerged from its ghetto and has been identified as a (priority) public health concern in view of the increasing age of the population. Considerable advances have been made in this disease over the last 15 Years, with progress in the following fields: knowledge of the underlying aetiopathogenetic, genetic and biochemical mechanisms; semiological, clinical and paraclinical approaches; creation of early diagnostic centres and multidisciplinary care networks; therapy available to patients or currently under development. The four existing acetylcholinesterase inhibitors having confirmed symptomatic action in patients with mild to moderate Alzheimer's disease have now been joined by memantine (Ebixa), a non-competitive agonist of N-methyl-D-aspartate (NMDA) receptors. One pathogenic mechanism of Alzheimer's disease appears to be hyperactivity of the glutaminergic neurons. Various preclinical studies have shown that memantine (Ebixa) inhibits glutaminergic hyperactivity in Alzheimer's disease through modulation of NMDA receptors. Since the early 1990s, several controlled clinical trials in patients with moderate to severe Alzheimer's disease (3<MMSE< or =14) have demonstrated the efficacy of memantine on cognitive criteria (cognitive evaluation of severe dementia) (Severe Impairment Battery--SIB), functional criteria (Functional Assessment Stage--FAST) and global clinical criteria (Clinician's Interview-Based Impression of Change--CIBIC-Plus). The data from these studies together with clinical experience of memantine in Germany since 1982 confirm the safety of use and good tolerability profile of this medication at the recommended dosages (10 to 30 mg/day). Treatment with memantine reduces the global costs of the disease by lightening the burden on helpers and delaying institutionalisation of patients. These different studies have resulted in approval of memantine in this particular indication by the European Medicines Agency. The efficacy of memantine in mild to moderate Alzheimer's disease is currently being assessed. The preliminary results also appear to militate in favour of the efficacy of the drug in certain forms of vascular dementia. Finally, the good safety profile of combined use of this drug with antiacetylcholinesterases opens up a realistic perspective of bitherapy in Alzheimer's disease.

Aged↗

PubMed1994

The exclusivity of the mother-child bond. Contributions from psychoanalytic and attachment theories and day-care research.

Both the psychoanalytic and the attachment theory literature have raised concerns about interfering with the mother-child bond during the child's first years. Their apprehension was that these disruptions could lead to psychopathology, some of which was considered serious and was classed as a disorder of attachment. The current research, discussed in this paper, challenges this view. Beginning in the first year of life, children seem capable of forming multiple bonds, while retaining the central importance of the mother-child bond. There is evidence that this core connection remains intact and has first priority in a child's mind regardless of other opportunities to relate. On the other hand, in spite of these findings, most researchers remain convinced that when the child is exposed to a disruption which exceeds his limits and which occurs on a chronic basis that a variety of disturbances may result. Some of these may be subtle and might not become manifest until later in the child's life. This paper attempts to explore the balance between the child's capacity to meet its basic needs through the core maternal relationship and collateral bonds, and the disruptive forces which actually are pathogenic.

Child Day Care Centers↗

PubMed2002

The metabolic syndrome, type 2 diabetes, and cardiovascular disease: understanding the role of insulin resistance.

The most common and clinically important complication in adults with diabetes is cardiovascular disease (CVD), which includes coronary heart disease, peripheral vascular disease, and stroke. Both type 2 diabetes and the insulin resistance syndrome are associated with a marked increase in the risk for CVD. The metabolic syndrome and the closely related insulin resistance syndrome have recently been recognized as important disorders, each being associated with an increase in CVD risk even in the absence of glucose intolerance. Given the significant public health burden of CVD, risk reduction has emerged as a significant clinical challenge for most practitioners. Diabetes and the insulin resistance syndrome are closely related disorders, with insulin resistance being more than a key pathogenic defect in type 2 diabetes. Even in the absence of glucose intolerance, these 2 disorders are both associated with a number of distinct pathologic findings, including hypertension, atherogenic dyslipidemia, a prothrombotic environment, and significant vascular and hemodynamic abnormalities that result from endothelial cell dysfunction. Insulin resistance is now recognized to be closely associated with the development of each of these risk factors. This article uses a case-based approach to discuss the unique features of insulin resistance and type 2 diabetes considered to be key contributors to CVD risk. A systematic approach to both evaluation and management is proposed, with priority given to therapies of demonstrated clinical benefit. Because of its critical and central role in the development of many CVD risk factors, targeted treatment of insulin resistance will also be discussed as such therapy may prove to be a critical component of care in years to come.

Cardiovascular Diseases↗