The insulin resistance syndrome has been recognized as an important new risk factor associated with premature coronary artery disease.

There seems to be a genetic trait because the underlying abnormality can also be demonstrated in offsprings of parents affected by this syndrome (49, 50).

Cardiovascular risk factors, such as hypertension, glucose intolerance, elevated levels of triglycerides combined with low levels of high-density lipoproteins (HDL), and impaired fibrinolytic activity, are detected with a higher frequency in these individuals than expected.

There is also considerable evidence that impaired aerobic exercise capacity is an important component of this syndrome. 

Muscle biopsies obtained from these individuals exhibit a reduction of mitochondrial and capillary density, not totally dissimilar from patients with congestive heart failure (51).

It has been speculated that the limited aerobic capacity of skeletal muscles may induce these patients to select a more sedentary lifestyle. 

Aerobic exercise in sufficient quantity has consistently been shown to ameliorate the effects of this syndrome and prevent progression to overt clinical disease.

Gerhard Schuler and Axel Linke
Department of Internal Medicine/Cardiology, University of Leipzig, Leipzig, Germany

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