Central Obesity and Insulin Resistance in the Cardiometabolic Syndrome: Pathways to Preclinical Cardiovascular Structure and Function
Johanna R. Klaus PhD
From the Behavioral Medicine Research Center, University of Miami, Miami, FL;
Department of Psychology, University of Miami, Coral Gables, FL;
Search for more papers by this authorBarry E. Hurwitz PhD
From the Behavioral Medicine Research Center, University of Miami, Miami, FL;
Department of Biomedical Engineering, University of Miami, Coral Gables, FL;
Search for more papers by this authorMaria M. Llabre PhD
From the Behavioral Medicine Research Center, University of Miami, Miami, FL;
Department of Psychology, University of Miami, Coral Gables, FL;
Search for more papers by this authorJay S. Skyler MD
Division of Endocrinology & Metabolism, School of Medicine, University of Miami, Miami, FL;
Search for more papers by this authorRonald B. Goldberg MD
Division of Endocrinology & Metabolism, School of Medicine, University of Miami, Miami, FL;
Search for more papers by this authorJennifer B. Marks MD
Division of Endocrinology & Metabolism, School of Medicine, University of Miami, Miami, FL;
Search for more papers by this authorMartin S. Bilsker MD
Division of Cardiology, School of Medicine, University of Miami, Miami, FL
Search for more papers by this authorNeil Schneiderman PhD
From the Behavioral Medicine Research Center, University of Miami, Miami, FL;
Department of Psychiatry and Behavioral Sciences, University of Miami, Miami, FL;
Search for more papers by this authorJohanna R. Klaus PhD
From the Behavioral Medicine Research Center, University of Miami, Miami, FL;
Department of Psychology, University of Miami, Coral Gables, FL;
Search for more papers by this authorBarry E. Hurwitz PhD
From the Behavioral Medicine Research Center, University of Miami, Miami, FL;
Department of Biomedical Engineering, University of Miami, Coral Gables, FL;
Search for more papers by this authorMaria M. Llabre PhD
From the Behavioral Medicine Research Center, University of Miami, Miami, FL;
Department of Psychology, University of Miami, Coral Gables, FL;
Search for more papers by this authorJay S. Skyler MD
Division of Endocrinology & Metabolism, School of Medicine, University of Miami, Miami, FL;
Search for more papers by this authorRonald B. Goldberg MD
Division of Endocrinology & Metabolism, School of Medicine, University of Miami, Miami, FL;
Search for more papers by this authorJennifer B. Marks MD
Division of Endocrinology & Metabolism, School of Medicine, University of Miami, Miami, FL;
Search for more papers by this authorMartin S. Bilsker MD
Division of Cardiology, School of Medicine, University of Miami, Miami, FL
Search for more papers by this authorNeil Schneiderman PhD
From the Behavioral Medicine Research Center, University of Miami, Miami, FL;
Department of Psychiatry and Behavioral Sciences, University of Miami, Miami, FL;
Search for more papers by this authorAbstract
The cardiometabolic syndrome (CMS) has been an organizing conceptual framework for subclinical cardiovascular pathophysiology. Using cross-sectional data from 338 healthy men and women aged 18 to 55 years, the study examined the role of central adiposity and insulin sensitivity and assessed potential relationships with other metabolic indices (insulin sensitivity, glucose tolerance, fibrinolysis, lipidemia, endothelial function, and inflammation) and measures of cardiac structure and function (cardiac mass, compliance and contractility, myocardial oxygen demand, and blood pressure). Structural equation modeling analyses, which controlled for sex, age, and race, demonstrated good fit to the data. The derived relationships provided a physiologically consistent model of CMS, with an initiating role for central adiposity and insulin resistance. The model accounted for 30% and 82% of the variance in diastolic blood pressure and myocardial oxygen demand, respectively. The findings suggest predominant pathways through which subclinical metabolic processes may exert pathogenic impact on the heart and vasculature.
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