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Psychosocial, Neuroendocrine, and Classical Risk Factors in Type 2 Diabetes
a New York Medical College, Valhalla, New York, USA b University College London, United Kingdom c Sahlgrenska University Hospital, Gothenburg, Sweden d University of Washington, Seattle, Washington, USA
Key Words: work stress • social epidemiology • neuroendocrine • adipokines • insulin resistance • antioxidants • adipocyte • glutathione • cell • bilirubin
Address for correspondence: N.G. Abraham, New York Medical College, Department of Pharmacology, Basis Science Building/Room 527, Valhalla, NY 10595. Voice: 914-594-4132; fax: 914-591-4273. nader_abraham{at}nymc.edu
This article summarizes some aspects of stress in the metabolic syndrome at the psychosocial, tissue, and cellular levels. The metabolic syndrome is a valuable research concept for studying population health and social–biological translation. The cluster of cardiovascular risk factors labeled the metabolic syndrome is linked with low socioeconomic status. Systematic differences in diet and physical activity contribute to social patterning of the syndrome. In addition, psychosocial factors including chronic work stress are linked with its development. Psychosocial factors could lead to metabolic perturbations and increase cardiovascular risk via activation of neuroendocrine responses, for example, in the autonomic nervous system and in several hormonal pathways. High glucocorticoid levels will promote lipid storage in visceral rather than subcutaneous adipose tissue. Adipocytes secrete several proinflammatory cytokines, which considered major contributors to increase in oxidants and cell injury. Upregulation of heme oxygenase 1 (HO-1) and peroxidase in the early development of diabetes produces a decrease in oxidative-mediated injury. Increased HO activity is associated with a significant decrease in superoxide, endothelial cell shedding and blood pressure. Finally, it is proposed that overexpression of glutathione peroxidase in
 cells may protect cell deterioration from oxidative stress during development of diabetes and hyperglycemia and this may result in attenuation of cell failure. If this proves to be the case, then the scene will be set to develop glutathione peroxidase mimetics for use in preclinical and clinical trials.
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