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VOLUME 1 ISSUE 3 CASE SW	SW is a 49-year-old man who presents for an employment physical. He has not seen a physician in the last 10 years, but considers himself healthy. He has had no hospitalizations as an adult.
PHYSICAL EXAM »  Height: 5 ft. 8 in. »  Weight: 200 lbs. »  Body mass index (BMI): 30 »  Waist circumference: 42 in. »  Pulse: 84 »  Blood pressure: 150/95 mm Hg »  Diminished pedal pulses »  Absent Achilles reflexes »  Remainder of examination is normal LABORATORY VALUES »  Fasting blood glucose: 118 mg/dL »  Uric acid: 9 mg/100 mL »  Remainder of chemistry panel is normal »  Lipid profile   --  Total cholesterol: 190 mg/dL   --  Triglycerides; 190 mg/dL   --  HDL: 19 mg/dL   --  Calculated LDL cholesterol: 133 mg/dL   --  hs CRP: 2.0 mg/dL (normal, <0.8)   --  Microalbumin/creatinine ratio: 40 µg/mg creatinine (normal, <30) NAVIGATION »  Q1: What findings are of concern to you at this visit? »  Q2: What other findings are suggestive of the Insulin Resistance Syndrome? »  Q3: How would you categorize SW’s blood pressure? »  Q4: What are the benefits of treating hypertension? »  Q5: What is the recommended initial therapy for patients with hypertension? »  Q6: What other management strategies would you institute at this time? »  Q7: How do you explain SW’s worsening lipid profile and fasting glucose levels? »  Q8: What is your diagnosis now? »  Q9: What are your treatment goals for SW? »  Q10: How should you modify SW’s antihypertensive regimen at this time?	Q: What other findings are suggestive of the Insulin Resistance Syndrome? A: SW displays several indicators that have been associated with the Insulin Resistance Syndrome. First, he has an elevated high sensitivity C-reactive protein (hs CRP) level, a marker of inflammation that has been associated with insulin resistance and which may identify patients at high risk for the development of acute coronary syndromes.2 His elevated plasma uric acid concentration, although not a sensitive predictor of insulin resistance, does increase the likelihood that he is insulin resistant. SW is also overweight—his BMI is 30 and his waist measurement is >40 inches. His microalbumin/creatinine ratio is high-normal; it should be monitored for progression to overt microalbuminuria (>30 µg/mg creatinine). Elevated albumin excretion is believed to represent a functional endothelial abnormality related to his underlying vascular disease process.
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