Clinical implications of carotid artery intima media thickness assessment on cardiovascular risk stratification in hyperlipidemic Korean adults with diabetes: the ALTO study.

BACKGROUND: The primary objective was to investigate prevalence of subclinical atherosclerosis in Korean individuals with diabetes and hyperlipidemia. Association of subclinical atherosclerosis with cardiovascular risk was assessed. METHODS: Assessments of carotid artery intima media thickness (cIMT) and atheromatous plaque were done using B-mode ultrasonography. Subclinical atherosclerosis was diagnosed based on presence of plaque, and/or increased cIMT versus mean cIMT reference values for Korean healthy controls. Atherosclerosis risk factors were analyzed using United Kingdom Prospective Diabetes Study (UKPDS) risk engine and Framingham Risk Score. RESULTS: In total, 355 patients were included; increased mean cIMT was observed in 15.3 % of patients, 69 % had >1 carotid artery plaque, and 72.7 % were diagnosed with subclinical atherosclerosis. In total, 60 % of subjects were taking statins, with low-density lipoprotein cholesterol level maintained ~80 mg/dL at enrollment. Carotid artery measures were well correlated with UKPDS and Framingham risk scores. Prevalence of subclinical atherosclerosis in the low risk group (<15 % 10-year UKPDS-predicted coronary heart disease risk) was 64.7 %; higher than predicted in previous studies. In multivariate analysis, advanced age was a significant risk factor for subclinical atherosclerosis in men and women, while increased waist circumference and longer diabetes duration were independent predictors only in women. CONCLUSION: Subclinical atherosclerosis is more prevalent among individuals with both diabetes and hyperlipidemia than in diabetic patients without additional cardiovascular risk factors. As conventional risk engines, based on modifiable risk factors may underestimate cardiovascular risk, early non-invasive carotid artery imaging screening may be warranted for patients with diabetes and hyperlipidemia, especially if they are elderly, have central obesity or have long duration of diabetes. TRIAL REGISTRATION: www.clinicaltrials.gov NCT01264263.

KSR2 is an essential regulator of AMP kinase, energy expenditure, and insulin sensitivity.

Kinase suppressors of Ras 1 and 2 (KSR1 and KSR2) function as molecular scaffolds to potently regulate the MAP kinases ERK1/2 and affect multiple cell fates. Here we show that KSR2 interacts with and modulates the activity of AMPK. KSR2 regulates AMPK-dependent glucose uptake and fatty acid oxidation in mouse embryonic fibroblasts and glycolysis in a neuronal cell line. Disruption of KSR2 in vivo impairs AMPK-regulated processes affecting fatty acid oxidation and thermogenesis to cause obesity. Despite their increased adiposity, ksr2(-/-) mice are hypophagic and hyperactive but expend less energy than wild-type mice. In addition, hyperinsulinemic-euglycemic clamp studies reveal that ksr2(-/-) mice are profoundly insulin resistant. The expression of genes mediating oxidative phosphorylation is also downregulated in the adipose tissue of ksr2(-/-) mice. These data demonstrate that ksr2(-/-) mice are highly efficient in conserving energy, revealing a novel role for KSR2 in AMPK-mediated regulation of energy metabolism.