You are carrying out a routine examination of a 54-year-old white male patient with a past medical history of hypertension. He has no complaints other than some dyspnea on exertion, which has been long-standing. Current medications include a thiazide diuretic and aspirin. He does not get much physical activity during the day. Physical examination indicates he is 5 ft 11 in tall, weighs 210 lb, has a waist circumference of 40.5 in, and a calculated BMI of 29 kg/m2. His blood pressure is 135/80 mm Hg sitting and 130/80 mm Hg standing. The rest of his physical examination is unremarkable. Blood work indicates total cholesterol of 230 mg/dL, HDL 38 mg/dL, LDL 152 mg/dL, triglycerides 200 mg/dL, and fasting plasma glucose 120 mg/dL. Based on these observations and test results this patient is the greatest risk for which of the following?

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The patient exhibits signs of metabolic syndrome, including obesity, hypertension, dyslipidemia, and elevated fasting glucose, which are risk factors for insulin resistance.  Insulin resistance (IR) refers to the situation whereby insulin interaction with its receptor fails to elicit downstream signaling events. Metabolically and clinically the most detrimental effects of IR are due to disruption in insulin-mediated control of glucose and lipid homeostasis in the primary insulinresponsive tissues: liver, skeletal muscle, and adipose tissue. IR is a characteristic feature found associated with obesity resulting in type 2 diabetes. In addition, IR is the hallmark feature of the metabolic syndrome (MetS). IR can occur for a number of reasons however, the most prevalent cause is the hyperlipidemic and proinflammatory states associated with obesity

You Are Carrying Out a Routine Examination of a 54-Year-Old