Metabolic syndrome from a gender and cardiovascular perspective Eva Swahn.

Metabolic syndrome from a gender Metabolic syndrome from a gender and cardiovascular perspectiveand cardiovascular perspective

Eva SwahnEva Swahn

IDF Worldwide Definition of the Metabolic Syndrome (2005)

The metabolic syndrome is a cluster of the most dangerous heart attack risk factors: diabetes and prediabetes, abdominal obesity, high cholesterol and high blood pressure.

•A quarter of the world’s adults have metabolic syndrome

•People with metabolic syndrome are twice as likely to die from, and three times as likely to have a heart attack or stroke compared with people without the syndrome •People with metabolic syndrome have a five-fold greater risk of developing type 2 diabetes

•Up to 80% of the 200 million people with diabetes globally will die of cardiovascular disease

Cardiovascular disease

Classical Risk Factors Novel Risk Factors

Metabolic syndromeMetabolic syndrome

T2DM Smoking LDL-C BP

AbdominalObesity

HDL-C

TG

TNF IL-6

PAI-1

Glu

Insulin

Cancer

DefinitionWaist in cm

Women >80 obsWomen >88 action

Men >94 obsMen >102 action

Prevention of coronary heart disease in clinical practice.Prevention of coronary heart disease in clinical practice.Eur Heart Journal 1998;19:1434-1503Eur Heart Journal 1998;19:1434-1503

Waist in cm

Women >80 69%Women >88 42%

Men >94 64%Men >102 32%

Waist in cm

Women >80 69%Women >88 42%

Men >94 64%Men >102 32%

Abdominal obesity in Abdominal obesity in Stockholm people Stockholm people (60 years old)(60 years old)

Health threat from abdominal obesity is largely due to intra-abdominal Health threat from abdominal obesity is largely due to intra-abdominal obesityobesity

AbdominalObesityDyslipidemia

HypertensionGlucose IntoleranceInsulin Resistance

Increased Cardiometabolic Risk

Intra-AbdominalAdiposity

Adapted from Eckel et al 2005

Nurses Health Study, 88 393 women, 34-59 yearsfollowed for 20 years, 1980-2000, healthy at study start.

Risk to get heart disease

Abdominal obesity

Overweight

The importance of abdominal obesity on theThe importance of abdominal obesity on therisk to get myocardial infarction risk to get myocardial infarction

Tricia Y.Li et al. Circulation 2006;113:499-506

Copenhagen city heart studyCopenhagen city heart study

0

0,5

1

1,5

2

2,5

3

WomenMen

EHJ (2002) 23, 620-626

Smoking

Diabetes

Psycosocialfactors

High lipidsFood

Alcohol High bloodpressure

OverweightAbdominal obesity

Thrombogenic factorscoagulation / fibrinolysis

Physicalactivity

Heredity InfectionInflammation

InterheartInterheart

Yusuf S et al, Lancet 2004;364:937-52

Moore Moore Less

0 5 10 15 20 25

Walking 4.8 km/h

Walking 3.2 km/h

Walking 1.6 km/h

Standing fidgeting

Standing motionless

Sitting fidgeting

Sitting motionless

Resting

Levine JA et al. Am J Clin Nutr 2000;72:1451

Energy use kJ/min

One cigarette shortens life with 2 min.

One beer shortens life with 4 min.

One working day shortens life with 8 hours!!!