Transcript
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Metabolic Syndrome
MAJ(P) J. Scott Earwood
Metabolic Syndrome
MAJ(P) J. Scott Earwood
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Goals
Define Metabolic Syndrome
Emphasize that visceral obesity is an
indicator of the syndrome and an
independent marker for CVD Review current and some potential future
treatment options
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An estimated 47 million people have
metabolic syndrome in the U.S.
NHANES III 1988-94, JAMA 2002
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ATP III Clinical Identification of the
Metabolic Syndrome
Waist circumference:
Men>102 cm (>40 in) Women>88 cm (>35 in)
Triglycerides >150 mg/dL
HDL cholesterol: Men100mg/dl increases risk for Metabolic Syndrome
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International Diabetes Federation
(IDF) Definition
Modified ATPIII definition
Fasting Glucose > 100mg/dl
Adjusted waist circumference based on
ethnicity (i.e. asians with lower waistcircumference threshold than pacific islanders)
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Lahey Clinic Study--50-60% of Pts
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Obesity is a Cardiovascular Risk
Factor:
Linear Increase in Risk for Cardiovascular
Disease with increase in BMI from 25 to 35
(unrelated to HDL, and LDL)
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Specifically, Visceral Obesity
Elevated waist circumference
TGWaist circumference)
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Look at your patients shape
http://images.google.com/imgres?imgurl=http://www.actden.com/grap_den/clipart/images/pear.jpg&imgrefurl=http://www.actden.com/grap_den/clipart/pear.htm&h=338&w=269&sz=26&tbnid=OENUH1ppgX60SM:&tbnh=119&tbnw=95&prev=/images%3Fq%3Dpear%2Bpicture&start=3&sa=X&oi=images&ct=image&cd=3http://metabolicsyndrome.about.com/od/exercise/p/MetabolicRate.htm8/13/2019 Earwood - Metabolic Syndrome
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Other Indicators of Metabolic
Syndrome and CV Risk
CRP
Borderline LDL
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EBM Recommendations
Any person at high risk or moderately high
risk who has lifestyle-related risk factors (e.g.,
obesity, physical inactivity, elevated
triglyceride, low HDL-C, or metabolicsyndrome) is a candidate for therapeutic
lifestyle changes to modify these risk factors
regardless of LDL-C level.
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EBM Recommendations (cont.)
There is some evidence that insulin
sensitizing agents such as metformin are
effective in treating features of metabolic
syndrome.
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Current Treatments
Weight reduction
TLC: Diet and Exercise
Lower BP goals
Lower LDL goals
Statins
Metformin
Aspirin therapy
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Possible New Markers
Adiponectin (cytokine released from
peripheral adipose tissue) low levels
associated with increased risk for MI
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Possible New Therapies
Endocannabinoid system
Phospholipid derivatives over-produced in
obese patients
CB1 receptor
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Possible New Therapies (Cont.)
CB1 receptorsanimal studies
Hypothalamusregulates energy metabolism
Liverlipogenesis
Adipose tissues Lipogenesis
Fat accumulation
Inhibition of adiponectin
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Possible New Therapies (Cont.)
RIO-LIPID trial (2005 NEJM)
Placebo group weight
2kg
4kg
Abdominal circumference
2.5cm
4.5cm
HDL-C
15%
CB1 receptor blocker weight
8kg
Abdominal circumference
9cm
HDL-C
25%
CRP 27%
Adiponectin 46%
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Summary
The definition for metabolic syndrome is
straight forward
We see these patients every day in our
practices Weight reduction is the key to preventing
CVD
There are some new exciting treatments onthe horizon
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Question?
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References
Third report of the National Cholesterol EducationProgram (NCEP) Expert Panel on Detection,Evaluation, and Treatment of High Blood Cholesterolin Adults (Adult Treatment Panel III). (2)Implicationsof recent clinical trials for the National Cholesterol
Education Program Adult Treatment Panel IIIGuidelines.
International Diabetes Federation
Insulin-sensitising drugs, The Cochrane Database ofSystematic Reviews Date of last Substantial Update:
December 31. 2002 Effects of Rimonabant on Metabolic Risk Factors in
Overweight Patients with Dyslipidemia, NEJM. Nov2005
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