concentration (Ͻ40 mg/dL in men, Ͻ50 mg/dL in women), and increased fasting glucose concentration (Ͼ110 mg/dL). The authors sought to determine whether metabolic syndrome is related to the extent of vascular damage in patients with manifestations of arterial disease. This was a cross-sectional survey of 502 patients derived from the Second Manifestations of Arterial Disease (SMART) study. Patients in this study were recently diagnosed with either coronary heart disease (n ϭ 502), stroke (n ϭ 236), peripheral arterial disease (n ϭ 218), or abdominal aortic aneurysm (n ϭ 89). Carotid intima media thickness, ankle-brachial index (ABI), and albuminuria were used as noninvasive markers of vascular damage. Values were adjusted for age and sex when appropriate.Metabolic syndrome was present in 45% of the study population. This included 57% of patients with peripheral arterial disease, 40% of patients with coronary heart disease, 43% of patients with stroke, and 45% of patients with abdominal aortic aneurysm. Patients with metabolic syndrome had increased intima media thickness (0.98 vs 0.92 mm; P Ͻ .01), more often decreased ABI (14% vs 10%; P ϭ .06), and increased prevalence of albuminuria (20% vs 15%; P ϭ .03) compared with patients without diagnosed metabolic syndrome. An increase in the number of components of metabolic syndrome was associated with an increase in mean intima medial thickening (P Ͻ .001), lower ABI (P Ͻ .01), and higher prevalence of albuminuria (P Ͻ .01).Comment: The data indicate that metabolic syndrome is a marker not only for increased risk for cardiovascular disease, but also for worse cardiovascular disease in patients with a manifestation of peripheral atherosclerosis. This is another bit of evidence to indicate the profound adverse health effects of obesity. Obesity is a risk factor not only for atherosclerosis, but also for more severe atherosclerosis.

• SABM occurs in several underlying conditions, most commonly anorexia nervosa and cachexia. • Abnormal marrow signal is often misinterpreted as technical error requiring unnecessary repeat imaging. • SABM is frequently associated with stress fractures. • Fractures in SABM can be obscured by marrow signal abnormality on MRI.

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Insulin resistance has been associated with the accumulation of fat within skeletal muscle fibers as intramyocellular lipid (IMCL). Here, we have examined in a cross-sectional study the interrelationships among IMCL, insulin sensitivity, and adiposity in European Americans (EAs) and African Americans (AAs). In 43 EA and 43 AA subjects, we measured soleus IMCL content with proton-magnetic resonance spectroscopy, insulin sensitivity with hyperinsulinemic–euglycemic clamp, and body composition with dual-energy X-ray absorptiometry. The AA and EA subgroups had similar IMCL content, insulin sensitivity, and percent fat, but only in EA was IMCL correlated with insulin sensitivity (r = −0.47, P < 0.01), BMI (r = 0.56, P < 0.01), percent fat (r = 0.35, P < 0.05), trunk fat (r = 0.47, P < 0.01), leg fat (r = 0.40, P < 0.05), and waist and hip circumferences (r = 0.54 and 0.55, respectively, P < 0.01). In a multiple regression model including IMCL, race, and a race by IMCL interaction, the interaction was found to be a significant predictor (t = 1.69, DF = 1, P = 0.0422). IMCL is related to insulin sensitivity and adiposity in EA but not in AA, suggesting that IMCL may not function as a pathophysiological factor in individuals of African descent. These results highlight ethnic differences in the determinants of insulin sensitivity and in the pathogenesis of the metabolic syndrome trait cluster.

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