Великобритания
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Global cardiometabolic risk*
Global cardiometabolic risk*
International Diabetes Federation (IDF) Consensus Definition 2005
International Diabetes Federation (IDF) Consensus Definition 2005
Central obesity: a driving force for cardiovascular disease & diabetes
Central obesity: a driving force for cardiovascular disease & diabetes
Central obesity: a driving force for cardiovascular disease & diabetes
Central obesity: a driving force for cardiovascular disease & diabetes
Central obesity: a driving force for cardiovascular disease & diabetes
Central obesity: a driving force for cardiovascular disease & diabetes
Intra-abdominal adiposity is closely correlated with abdominal obesity
Intra-abdominal adiposity is closely correlated with abdominal obesity
Intra-abdominal adiposity is closely correlated with abdominal obesity
Intra-abdominal adiposity is closely correlated with abdominal obesity
Intra-abdominal adiposity is a major contributor to increased
Intra-abdominal adiposity is a major contributor to increased
Waist Circumference
Waist Circumference
Insulin Resistance: Associated Conditions
Insulin Resistance: Associated Conditions
Cardiometabolic Syndrome Nabil Sulaiman HOD Family and Community
Cardiometabolic Syndrome Nabil Sulaiman HOD Family and Community
Cardiometabolic Syndrome Nabil Sulaiman HOD Family and Community
Cardiometabolic Syndrome Nabil Sulaiman HOD Family and Community
Cardiometabolic Syndrome Nabil Sulaiman HOD Family and Community
Cardiometabolic Syndrome Nabil Sulaiman HOD Family and Community
Cardiometabolic Syndrome Nabil Sulaiman HOD Family and Community
Cardiometabolic Syndrome Nabil Sulaiman HOD Family and Community
Treatment of Metabolic Syndrome: 2005
Treatment of Metabolic Syndrome: 2005
Treatment of Metabolic Syndrome: 2005
Treatment of Metabolic Syndrome: 2005
Recommendations for treatment
Recommendations for treatment
Management of the Metabolic Syndrome
Management of the Metabolic Syndrome
Cardiometabolic Syndrome Nabil Sulaiman HOD Family and Community
Cardiometabolic Syndrome Nabil Sulaiman HOD Family and Community
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Cardiometabolic Syndrome Nabil Sulaiman HOD Family and Community Medicine, Sharjah University and University of Melbourne Dr Dhafir A. Mahmood Consultant Endocrinologist Al- Qassimi Al-Kuwait Hospital Sharjah

содержание презентации «Cardiometabolic Syndrome Nabil Sulaiman HOD Family and Community Medicine, Sharjah University and University of Melbourne Dr Dhafir A. Mahmood Consultant Endocrinologist Al- Qassimi Al-Kuwait Hospital Sharjah.ppt»
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1Cardiometabolic Syndrome Nabil 41mg% (<1.7 mmol /l) Multiple major
Sulaiman HOD Family and Community studies show 24 - 37% reductions in
Medicine, Sharjah University and cardiovascular disease risk with use of
University of Melbourne & Dr Dhafir A. statins and fibrates in the control of
Mahmood Consultant Endocrinologist Al- hyperlipidemia.
Qassimi & Al-Kuwait Hospital Sharjah. 42Substantial residual cardiovascular
2Cardiometabolic Syndrome II Aims. risk in statin-treated patients. The
Abdominal obesity prevalence Targeting MRC/BHF Heart Protection Study. 30. 20.
Cardiometabolic Risk factors Multiple Risk Risk reduction=24% (p<0.0001). 19.8% of
Factor management A Critical Look at the statin-treated patients had a major
Metabolic Syndrome. cardiovascular event by 5 years. %
3Clustering of Components: patients. 10. 0. 0. 1. 2. 3. 4. 5. 6. Year
Hypertension: BP. > 140/90 of follow-up. Placebo Statin. Heart
Dyslipidemia: TG > 150 mg/ dL ( 1.7 Protection Study Collaborative Group,
mmol/L ) HDL- C < 35 mg/ dL (0.9 2002.
mmol/L) Obesity (central): BMI > 30 43Medications: Hypertension: ACE
kg/M2 Waist girth > 94 cm (37 inch) inhibitors, ARBs Others - thiazides,
Waist/Hip ratio > 0.9 Impaired Glucose calcium channel blockers, beta blockers,
Handling: IR , IGT or DM FPG > 110 alpha blockers Central acting Alfa agonist
mg/dL (6.1mmol/L) 2hr.PG >200 : Moxolidin Dylipidemia: Statins,
mg/dL(11.1mmol/L) Microalbuninuria (WHO). Fibrates, Niacin Platelet inhibitors: ASA,
4Global cardiometabolic risk*. Gelfand clopidogrel.
EV et al, 2006; Vasudevan AR et al, 2005. 44
* working definition. 45Antihypertensive Medications: Target
5International Diabetes Federation BP: <130/80 Angiotensin -converting
(IDF) Consensus Definition 2005. The new Enzyme Inhibitors (ACEI) Angiotensin II
IDF definition focusses on abdominal Receptor (ARB) Blockers Combination with
obesity rather than insulin resistance. Thiazides, Calcium Channel Blockers,
6Why a New Definition of the MeS: IDF Cardioselective Beta Blockers.
Objectives. Needs: To identify individuals 46
at high risk of developing cardiovascular 47
disease (and diabetes) To be useful for 48Individual metabolic abnormalities
clinicians To be useful for international among Qatari population according to
comparisons. gender (Musallam et al 08). Men (n = 405)
7Central Obesity. IDF: Central obesity Women (n=412) Variable n(%) n(%) p-Value
- waist circumference >94 cm for ATP III Abdominal obesity 227(56.0)
Europid men, >80 Europid women with 308(74.8) <0.001 Hypertension 143(35.3)
ethnicity specific values for other groups 156(37.9) 0.448 Diabetes 77(19.0)
WHO: Waist-hip ratio >0.9 - men or 107(26.0) 0.017 Hypertriglyceridemia
>0.85 - women ATP III: Waist 113(27.9) 83(20.1) 0.009 Low HDL 95(23.5)
circumference >40 in. - men, > 35 121(29.4) 0.055.
in. - women. 49Individual metabolic abnormalities
8Fat Topography In Type 2 Diabetic among Qatari population according to
Subjects. Intramuscular. Subcutaneous. gender. No of components of ATP III. Men
Intrahepatic. Intra- abdominal. (n = 405) Women (n=412) Variable n(%) n(%)
9Abdominal obesity and increased risk p-Value None 88(21.7) 74(18.0) – One
of cardiovascular events. The HOPE study. 103(25.4) 100(24.3) 0.033 Two 125(30.9)
1.4. 1.2. Adjusted relative risk. 1. 0.8. 111(26.9) – Three or more 89(22.0)
1.35. 1.29. 1.27. 1.17. 1.16. 1.14. 1. 1. 127(30.8) –.
1. CVD death. MI. All-cause deaths. 50Prevalence of MeS in different
Adjusted for BMI, age, smoking, sex, CVD Countries. Country. Year. Sample.
disease, DM, HDL-cholesterol, total-C; Prevalence (%). Arab Americans. 2003. 542.
CVD: cardiovascular disease; MI: 23. Oman. 2001. 1419. 21. Jordan. 2002.
myocardial infarction; BMI: body mass 1121. 36. Saudi Arabia. 2004. 2250. 20.8.
index; DM: diabetes mellitus; HDL: Palestine. 1998. 17*. Qatar. 2007. 817.
high-density lipoprotein cholesterol. Men. 27.6. Turkey. 2004. 1637. 33.4*. Iran. ?
Women. Tertile 1. <95. <87. Waist 10368. 33.7. * Crude rates Mussallam et
circumference (cm): Tertile 2. 95–103. al. Int J Food Safety and PH 2008.
87–98. Tertile 3. >103. >98. 51Is it a Syndrome?* “…too much
Dagenais GR et al, 2005. clinically important information is
10Abdominal obesity increases the risk missing to warrant its designations as a
of developing type 2 diabetes. 24. 20. 16. syndrome.” Unclear pathogenesis, Insulin
12. 8. 4. 0. Relative risk. Waist resistance is not a consistent finding in
circumference (cm). <71. 71–75.9. some definitions. CVD risks has not shown
76–81. 81.1–86. 86.1–91. 91.1–96.3. to be greater than the sum of it’s
>96.3. Carey VJ et al, 1997. individual components. *ADA. A Critical
11Abdominal obesity is linked to an Look at the Metabolic Syndrome.
increased risk of coronary heart disease. 52A Critical Look at the Metabolic
Waist circumference has been shown to be Syndrome. Research “Until much needed
independently associated with increased research is completed, clinicians should
age-adjusted risk of CHD, even after evaluate and treat all CVD risk factors
adjusting for BMI and other cardiovascular without regard to whether a patient meets
risk factors. CHD: coronary heart disease; the criteria for diagnosis of the
BMI: body mass index. Rexrode KM et al, ‘metabolic syndrome’.”.
1998. 53A Critical Look at the Metabolic
12Diabetes. Diabetes in the new Syndrome. Lifestyle The advice remains to
millennium Interdisciplinary problem. treat individual risk factors when present
13OBESITY. Diabetes in the new & to prescribe therapeutic lifestyle
millennium Interdisciplinary problem. changes & weight management for obese
14DIAB ESITY. Diabetes in the new patients with multiple risk factors.
millennium Interdisciplinary problem. 54Insulin Resistance: Associated
15Targeting Cardiometabolic Risk. Conditions.
16Central obesity: a driving force for 55Thank You.
cardiovascular disease & diabetes. 56
“Balzac” by Rodin. Front. Back. 57Determinants and dynamics of the CVD
17Intra-abdominal adiposity is closely Epidemic in the developing Countries. Data
correlated with abdominal obesity. 300. r from South Asian Immigrant studies Excess,
= 0.80. 200. IAA (cm2). 100. IAA. 0. 60. early, and extensive CHD in persons of
80. 100. 120. Waist circumference (cm). To South Asian origin The excess mortality
assess IAA, the simplest measure of has not been fully explained by the major
abdominal obesity is waist circumference, conventional risk factors. Diabetes
which is strongly correlated with direct mellitus and impaired glucose tolerance
measurement of IAA by CT scan or MRI, highly prevalent. (Reddy KS, circ 1998).
considered to be the gold standard. IAA: Central obesity, ?triglycerides, ?HDL with
intra-abdominal adiposity; CT: computed or without glucose intolerance,
tomography; MRI: magnetic resonance characterize a phenotype. genetic factors
imaging. Despr?s JP et al, 2001; Pouliot predispose to ?lipoprotein(a) levels, the
MC et al, 2004. central obesity/glucose
18Intra-abdominal adiposity is a major intolerance/dyslipidemia complex
contributor to increased cardiometabolic collectively labeled as the “metabolic
risk. IAA = high risk fat. Increased syndrome”.
cardiometabolic risk. Dyslipidaemia. 58Determinants and dynamics of the CVD
Insulin resistance. Inflammation. IAA: epidemic in the developing countries.
intra-abdominal adiposity. Kershaw EE et Other Possible factors Relationship
al, 2004; Lee YH et al, 2005; Boden G et between early life characteristics and
al, 2002. susceptibility to NCD in adult hood (
19Waist Circumference. Barker’s hypothesis) (Baker DJP,BMJ,1993)
20Intra-abdominal adiposity and Low birth weight associated with increased
dyslipidaemia. Triglycerides. CVD Poor infant growth and CVD relation
HDL-cholesterol. 310. 60. 248. 186. mg/dL. Genetic–environment interactions (Enas EA,
mg/dL. 45. 124. 62. 30. 0. Low. High. Clin. Cardiol. 1995; 18: 131–5)
Lean. Low. High. Lean. Visceral fat (obese Amplification of expression of risk to
subjects). Visceral fat (obese subjects). some environmental changes esp. South
HDL: high-density lipoprotein. Pouliot MC Asian population) Thrifty gene (e.g. in
et al, 1992. South Asians).
21Insulin Resistance: Associated 59CVD epidemic in developing &
Conditions. developed countries. Are they same? Urban
22Targeting Cardiometaboilc Risk populations have higher levels of CVD risk
Defining cardiometabolic Risk. factors related to diet and physical
Cardiovascular Disease Abdominal Obesity activity (overweight, hypertension,
Glucose intolerance Insulin Resistance dyslipidaemia and diabetes) Tobacco
Dyslipedemia Hypertension. consumption is more widely prevalent in
23Targeting Cardiometaboilc Risk rural population The social gradient will
Defining cardiometabolic Risk. Major Unmet reverse as the epidemics mature. The poor
Clinical Need Classical Risk Factors Novel will become progressively vulnerable to
Risk Factors Cluster Risk Factors LDL-C BP the ravages of these diseases and will
Smoking DM-2 Insulin HDL-C TNF & IL-6 have little access to the expensive and
Abdominal Obesity Glucose PAI-1 TG technology-curative care. The scarce
Cardiovascular Disease. societal resources to the treatment of
24Linked Metabolic Abnormalities: these disorders dangerously depletes the
Impaired glucose handling/ insulin resources available for the ‘unfinished
resistance Atherogenic dyslipidemia agenda’ of infectious and nutritional
Endothelial dysfunction Prothrombotic disorders that almost exclusively afflict
state Hemodynamic changes Proinflammatory the poor.
state Excess ovarian testosterone 60Coronary heart disease Mortality
production Sleep-disordered breathing. statistics Specific mortality data ideal
25Resulting Clinical Conditions: Type 2 for making comparisons with other
diabetes Essential hypertension Polycystic countries are not available Inadequate and
ovary syndrome (PCOS) Nonalcoholic fatty inappropriate death certification, and
liver disease Sleep apnea Cardiovascular multiple concurrent causes of death.
Disease (MI, PVD, Stroke) Cancer (Breast, Burden of CVD in Pakistan.
Prostate, Colorectal, Liver). 61Central obesity: a driving force for
26Targeting Cardiometaboilc Risk. Site cardiovascular disease & diabetes.
of Action Mechanisms Addresses Adipose “Balzac” by Rodin. Front. Back.
tissues Adiponectin Dyslipidemia 62Why people physically inactive? Lack
Lipogeenesis Insulin resistance Muscle G of awareness regarding the of physical
uptake Insulin resistance Liver activity for health fitness and prevention
Lipogeenesis Dyslipidemia Insulin of diseases Social values and traditions
resistance GI tract Satiety signals Body regarding physical exercise (women,
weight Waist circumference Hypothalamus restriction). Non-availability public
Food intake Body weight Waist places suitable for physical activity
circumference Genetic? (walking and cycling path, gymnasium).
27Multiple Risk Factor Management. Modernization of life that reduce physical
Obesity Glucose Intolerance Insulin activity (sedentary life, TV, Computers,
Resistance Lipid Disorders Hypertension tel, cars).
Goals: Minimize Risk of Type 2 Diabetes 63Insulin Resistance: Associated
and Cardiovascular Disease. Conditions.
28Glucose Abnormalities: IDF: FPG 64Prevalence of the Metabolic Syndrome
>100 mg/dL (5.6 mmol. L) or previously Among US Adults NHANES 1988-1994.
diagnosed type 2 diabetes (ADA: FBS 1999-2002 Prevalence by IDF vs. NCEP
>100 mg/dL [ 5.6 mmol/L ]). Definitions (Ford ES, Diabetes Care 2005;
29Hypertension: IDF: BP >130/85 or on 28: 2745-9) (unadjusted, age 20+) NCEP :
Rx for previously diagnosed hypertension. 33.7% in men and 35.4% in women IDF: 39.9%
30Dyslipidemia: IDF: Triglycerides - in men and 38.1% in women. Age (years).
>150mg/dL (1.7 mmol /L) HDL - <40 Ford E et al. JAMA. 2002(287):356.
mg/dL (men), <50 mg/dL (women). 65
31Insulin Resistance: Hyperinsulinemic 66Prevention of CVD. There is an urgent
individuals are at risk for developing need to establish appropriate research
Diabetes, Dyslipidemia, Hypertension & studies, increase awareness of the CVD
ultimately Cardiovascular disease Patients burden, and develop preventive strategies.
with Metabolic Syndrome are 3.5 times as Prevention and treatment strategies that
likely to die from Cardiovascular disease have been proven to be effective in
compared to normal people. developed countries should be adapted for
32Public Health Approach. developing countries. Prevention is the
33Screening/Public Health Approach. best option as an approach to reduce CVD
Public Education Screening for at risk burden. Do we know enough to prevent this
individuals: Blood Sugar/ HbA1c Lipids CVD Epidemic in the first place.
Blood pressure Tobacco use Body habitus 67International Diabetes Federation
Family history. (IDF) Consensus Definition 2005. The new
34Exercise Improves CV fitness, weight IDF definition focusses on abdominal
control, sensitivity to insulin, reduces obesity rather than insulin resistance.
incidence of diabetes Weight loss Improves 68International Diabetes Federation
lipids, insulin sensitivity, BP levels, (IDF) Consensus Definition 2005. Central
reduces incidence of diabetes Goals: Brisk Obesity. Central Obesity. Waist
walking - 30 min./day 10% reduction in circumference – ethnicity specific* – for
body wt. Life-Style Modification: Is it Europids: Male > 94 cm Female > 80
Important? cm. Waist circumference – ethnicity
35Smoking Cessation / Avoidance: A risk specific* – for Europids: Male > 94 cm
factor for development in children and Female > 80 cm. plus any two of the
adults Both passive and active exposure following: plus any two of the following:
harmful A major risk factor for: insulin Raised triglycerides. > 150 mg/dL (1.7
resistance and metabolic syndrome mmol/L) or specific treatment for this
macrovascular disease (PVD, MI, Stroke) lipid abnormality. Reduced HDL
microvascular complications of diabetes cholesterol. < 40 mg/dL (1.03 mmol/L)
pulmonary disease, etc. in males < 50 mg/dL (1.29 mmol/L) in
36Diabetes Control - How Important? females or specific treatment for this
Goals: FBS - premeal <110, postmeal lipid abnormality. Raised blood pressure.
<180. HbA1c <7% For every 1% rise in Systolic : > 130 mmHg or Diastolic:
Hb A1c there is an 18% rise in risk of > 85 mmHg or Treatment of previously
cardiovascular events & a 28% increase diagnosed hypertension. Raised fasting
in peripheral arterial disease Evidence is plasma glucose. Fasting plasma glucose
accumulating to show that tight blood > 100 mg/dL (5.6 mmol/L) or Previously
sugar control in both Type 1 and Type 2 diagnosed type 2 diabetes If above 5.6
diabetes reduces risk of CVD. mmol/L or 100 mg/dL, OGTT is strongly
37Lifestyle modification. If a 1% recommended but is not necessary to define
reduction in HbA1c is achieved, you could presence of the syndrome.
expect a reduction in risk of: 21% for any 69Treatment of Metabolic Syndrome: 2005.
diabetes-related endpoint 37% for 70Recommendations for treatment. Primary
microvascular complications 14% for management for the Metabolic Syndrome is
myocardial infarction. Diet Exercise healthy lifestyle promotion. This
Weight loss Smoking cessation. However, includes: moderate calorie restriction (to
compliance is poor and most patients will achieve a 5-10% loss of body weight in the
require oral pharmacotherapy within a few first year) moderate increases in physical
years of diagnosis. Stratton IM et al. BMJ activity change dietary composition to
2000; 321: 405–412. reduce saturated fat and total intake,
38Overcome Insulin Resistance/ Diabetes: increase fibre and, if appropriate, reduce
Insulin Sensitizers: Biguanides – salt intake.
metformin Glitazones, Gltazars Can be used 71Management of the Metabolic Syndrome.
in combination Insulin Secretagogues: Appropriate & aggressive therapy is
Sulfonylurea - glipizide, glyburide, essential for reducing patient risk of
glimeparide, glibenclamide Meglitinides - cardiovascular disease Lifestyle measures
repaglanide, netiglamide. should be the first action Pharmacotherapy
39Insulin. Insulin Analogues: Lyspro should have beneficial effects on Glucose
/Aspart /glulysine used with meals intolerance/diabetes Obesity Hypertension
Glargine & Livemer as basal insulin Dyslipidaemia Ideally, treatment should
Continuous Subcutaneous Insulin Infusion address all of the components of the
(CSII) NPH/Regular, NPH/logs - Mixed or in syndrome and not the individual
fixed combinations (70/30, 75/25, 50/50) components.
Insulin combined with oral agents. 72Summary: new IDF definition for the
40BP Control - How Important? Goal: Metabolic Syndrome. The new IDF definition
BP.<130/80 MRFIT and Framingham Heart addresses both clinical and research
Studies: Conclusively proved the increased needs: provides a simple entry point for
risk of CVD with long-term sustained primary care physicians to diagnose the
hypertension Demonstrated a 10 year risk Metabolic Syndrome providing an
of cardiovascular disease in treated accessible, diagnostic tool suitable for
patients vs non-treated patients to be worldwide use, taking into account ethnic
0.40. 40% reduction in stroke with control differences establishing a comprehensive
of HTN Precedes literature on Metabolic ‘platinum standard’ list of additional
Syndrome. criteria that should be included in
41Lipid Control - How Important? Goals: epidemiological studies and other research
HDL >40 mg% (>1.1 mmol /l) LDL into the Metabolic Syndrome.
<100 mg/dL (<3.0 mmol /l) TG <150 73
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900igr.net > Презентации по английскому языку > Великобритания > Cardiometabolic Syndrome Nabil Sulaiman HOD Family and Community Medicine, Sharjah University and University of Melbourne Dr Dhafir A. Mahmood Consultant Endocrinologist Al- Qassimi Al-Kuwait Hospital Sharjah