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STATE-OF-THE-ART PAPER

Inflammatory Markers and the Metabolic Syndrome

Insights From Therapeutic Interventions

Kwang Kon Koh, MD, PhD, FACC^_*,_*, Seung Hwan Han, MD^_* and Michael J. Quon, MD, PhD

^_* Division of Cardiology, Gil Heart Center, Gachon Medical School, Incheon, Korea
Diabetes Unit, Laboratory of Clinical Investigation, National Center for Complementary and Alternative Medicine, National Institutes of Health, Bethesda, Maryland

Manuscript received April 16, 2005; revised manuscript received June 22, 2005, accepted June 27, 2005.

^_* Reprint requests and correspondence: Dr. Kwang Kon Koh, Vascular Medicine and Atherosclerosis Unit, Division of Cardiology, Gil Heart Center, Gachon Medical School, 1198 Kuwol-dong, Namdong-gu, Incheon, South Korea 405-760 (Email: kwangk{at}ghil.com).

Inflammation in the vasculature might be an important pathogenic link between cardiovascular diseases and the metabolic syndrome. Inflammation can be reduced by a variety of approaches including diet, exercise, cardiovascular drugs, and insulin sensitizers. Importantly, these different measures improve vascular function and reduce inflammation by distinct mechanisms. Therefore, combination therapy including lifestyle modifications and multiple drugs from separate classes might produce additive beneficial outcomes. We review plausible mechanisms for effects of combination therapy to reduce inflammation, improve endothelial dysfunction, and decrease insulin resistance in atherosclerosis, coronary heart disease, and hypertension in the context of insulin-resistant states including diabetes, obesity, and the metabolic syndrome.

Abbreviations and Acronyms   ACE = angiotensin-converting enzyme   CAMs = cell adhesion molecules   CRP = C-reactive protein   ICAM = intercellular adhesion molecule   IL = interleukin   LDL = low-density lipoprotein   MCP = monocyte chemoattractant protein   NF = nuclear factor   NO = nitric oxide   PPAR = peroxisome proliferator-activated receptor   sCD40L = soluble CD40 ligand   TNF = tumor necrosis factor   VCAM = vascular cell adhesion molecule

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