The latest meeting of the Metabolic Syndrome Institute (MSI), held in Paris on 14 and 15 December 2007, focused on microvascular and macrovascular disease.

Professor Stevo Julius opened the Friday morning session by addressing the thorny issue of how early we should treat hypertension or its pre-states, to prevent hypertensive macrovascular disease. He argued that there are good reasons to treat early, including the observation that the natural history of blood pressure elevation and morbidity in hypertension is not linear, but rather exponential, and the fact that borderline phase hypertension is already associated with numerous pathophysiologic and metabolic abnormalities. Professor Julius views prehypertension and stage 1 hypertension as the deadliest forms of hypertension.

In the next presentation, “Microvessels and atherosclerosis in humans”, Professor Valentin Fuster reported imaging work that shows how vasa vasorum–derived microvessels nurture atherosclerotic plaque, and considered whether such plaque neovessels could in the future be used for risk stratification.

The afternoon session began with a presentation by Professor Paul Dodson on prevention of diabetic retinopathy, which causes 11% of blindness in the Western World, and the case for lipid-modifying therapy with fibrates in the light of data from the FIELD trial.

Professor George King then spoke about protein kinase C activation in mechanisms of the metabolic syndrome, and cardiovascular pathologies in diabetic subjects, such as atherosclerosis, restenosis, cardiomyopathy, and cardiac fibrosis, which may result from increased expression of the potent pro-fibrotic factor, connective tissue growth factor, as reported in the myocardium of diabetics.

Professor Masayuki Yoshida then reviewed the roles of apolipoprotein CIII and protein kinase C in insulin resistance and endothelial cell dysfunction. He presented evidence that apolipoprotein CIII not only modulates lipoprotein metabolism, but may also contribute directly to atherogenesis through insulin resistance and endothelial dysfunction.

The afternoon session was completed by a presentation by Professor Frank Sacks, on the role of apolipoprotein CIII as a strong predictor of cardiovascular disease, and on how it affects VLDL and LDL metabolism in humans and contributes to atherogenic dyslipidemia and vascular pathology.

Professor Paola Fioretto opened the Saturday morning session with a talk on the histopathology of diabetic nephropathy, in which she presented the first evidence in humans that established lesions of diabetic glomerulopathy are reversible after ten years of euglycemia.

Professor Bart Staels concluded the session with a presentation on vascular inflammation, microvascular disease, and peroxisome proliferator-activated receptor a, which improves endothelial function by lowering leukocyte recruitment, enhancing vasorelaxation, and reducing vasoconstriction. It also affords microvascular protection through its action on macrophages (inflammation control, cholesterol homeostasis), smooth muscle cells (vascular remodeling), and endothelial cells.

The meeting was also the occasion for the selection of the winning applications for the 2007 MSI Awards.

Professor Michel Hermans presented a preselection of six research proposals, and an anonymous vote among the MSI Scientific Committee members selected the three winners:

1. a Mexican study of the effects of simultaneous intervention using a school-based program and primary care-based multidisciplinary clinical intervention on obesity rates and major obesity co-morbidities
2. a South African study of biological markers associated with higher sympathetic activity in urbanized black teachers
3. an Australian study of the impact of metabolic syndrome and its components on cardiovascular disease development, cause-specific mortality, diabetes and other outcomes, and comparison of cardiovascular and mortality outcomes in Europid, South Asian Indian, Chinese, and Creole patients.

These three 10 000 US $ awards are intended to encourage young researchers and clinicians to do original research in the fight against the metabolic syndrome.