Metabolic Syndrome

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Slide 1 :

Metabolic Syndrome Cut Off Experience Developed by Sepehr Nowfar Class of 2005

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Slide 3 :

I. Background

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Relevance to Primary Care More than one in five Americans has metabolic syndrome. The incidence of metabolic syndrome increases with age, affecting more than 40% of people in their 60s and 70s.

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Millions of Adults Who Need Lifestyle and Drug Treatment TLC only TLC + Rx CHD and CHD Risk Equivalents 24.1 20.710-year risk >20% 2+ Risk Factors 10.9 8.310-year risk 10-20% 2+ Risk Factors 14.6 2.810-year risk <10% 0-1 Risk Factor 15.6 4.7 Total 65.3M 36.5M

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Relevance to Population: HP2010 Objectives Physical Activity Overweight and Obesity Tobacco Use Access to Health Care Substance Abuse Responsible Sexual Behavior Mental Health Injury and Violence Environmental Quality Immunization

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Problem: General Features of Metabolic Syndrome Abdominal obesity Atherogenic dyslipidemia Elevated triglycerides high LDL Low HDL Raised blood pressure Insulin resistance (? glucose intolerance) Prothrombotic state Proinflammatory state

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Problem: Metabolic SyndromeMorbidity/Mortality Heart Disease/Stroke Renal Damage Increased blood clotting NIDDM

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Methods to gather info EBM: metabolic syndrome, screening, Louisiana, compliance Walter Birdsall, MD Lady of the Sea Patient and Provider Input

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Methods to gather info, con’t Adult Treatment Protocol III (NCEP) American Diabetic Association National Heart, Lung, Blood Institute National Institutes of Health HP2010

Slide 11 :

Methods to gather info, con’t ATP III systematic review and judgment which reports provided relevant information synthesis of existing literature into a series of evidence statements expert panel consensus and recommendations publication of recommendations and guidelines

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II. Screening Protocol and Patient Education

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Findings:Metabolic Syndome Criteria Waistline >40” men, >35” women Blood Pressure > 130/85 mmHg Fasting Blood Glucose >110mg/dl Postprandial Blood Glucose >140 mg/dl HDL <40 mg/dl men, <50 mg/dl women Triglycerides >150 mg/dl

Slide 14 :

Interpretation and conclusions Target: 20 - 60 year-olds no prior knowledge of risk Community screening for risk factors Framingham 10-year CHD projections Therapeutic Lifestyle Changes Drug Therapy

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Interpretation and conclusions Worksites were targeted because they seldom have their own work-site health promotions programs Interested company owners/managers were approached Education program

Slide 16 :

Application: Community Outreach and Screening Hospital Employees Shipyards Rotary Clubs/Knights of Columbus Church Organizations Youth Sports

Slide 17 :

Application: Screeners Diabetic Educator Nicoles State Nursing Students Vo-Tech Nursing Students Volunters

Slide 18 :

Application:glucose monitors and strips Drug representatives Employers Newspaper coverage

Slide 19 :

Product Process Map Questionnarrie Summary Presentation Risk Assessment and resources Outline of healthier eating habits Food/Exercise diary Translated medical definitions Listing of local family providers

Slide 20 :

Senior Wellness Clinc

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Lady of the Sea Employee Screen

Slide 22 :

III. Provider Education

Slide 23 :

Continuing Medical Education:When to begin screenings Anyone at least 20 years old Get a baseline FLP (T. Chol, LDL, HDL, TG) If low risk, screen q 5 years If high risk, follow ATP III guidelines Once LDL under control, screen q 4-6 mo

Slide 24 :

Findings: Metabolic SyndromePrevention, Low Risk Lose Weight, begin with 5-10% Exercise, 30 min 6-days a week Dietary changes CHO <50% Limit alcohol Discontinue tobacco

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Findings: Metabolic SyndromePrevention, High Risk All guidelines listed under low risk Drug Therapy Statins, bile acid sequestrants ?LDL nicotinic acid, fibric acid ?HDL, ?TG aspirin for CHD patients to reduce prothrombotic state

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Reinforce reductionin saturated fat andcholesterol Consider addingplant stanols/sterols Increase fiber intake Consider referral toa dietitian Initiate Tx forMetabolicSyndrome Intensify weightmanagement &physical activity Consider referral to a dietitian 6 wks 6 wks Q 4-6 mo Emphasizereduction insaturated fat &cholesterol Encouragemoderate physicalactivity Consider referral toa dietitian CME: A Model of Steps in Therapeutic Lifestyle Changes (TLC) MonitorAdherenceto TLC Visit N

Slide 27 :

If LDL goal not achieved, intensifyLDL-lowering therapy If LDL goal not achieved, intensify drug therapy or refer to a lipid specialist Monitor response and adherence to therapy Start statin or bile acid sequestrant or nicotinic acid Consider higher dose of statin or add a bile acid sequestrant or nicotinic acid 6 wks 6 wks Q 4-6 mo If LDL goal achieved, treat other lipid risk factors Initiate LDL-lowering drug therapy CME: Drug Treatment

Slide 28 :

LDL Cholesterol Goals and Cutpoints for Therapeutic Lifestyle Changes (TLC) and Drug Therapy

Slide 29 :

Product Summary presentation ATP III Quick Desk Reference Framingham 10-year CHD projections

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IV. Continuing Outcome Monitoring

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Enhancing Adherence Keep the regimen as simple as possible Give the patient clear instructions Discuss adherence at each visit Keep Diaries (BP, Glc, food) Concentrate on those who don’t reach goals Always call patients who miss appointments

Slide 32 :

Population input: What motivated other patients? Watching a love one die Watching a love one develop handicaps Having a heart attack or surgery Impotence, Blindness Decreased attractiveness Keeping kids from getting retirement money

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V. Miscellaneous

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Limitations Targeted patients are characteristically most reluctant to receive medical care Loss of patients to follow-up Operator error Clothing, waist circumference, BP Non-fasting blood glucose Osteoarthritis, other handicaps

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Limitations, con’t Not all risk factors documented Modified Framingham 9/11 post-safety concerns Economy

Slide 36 :

Relevant Literature www.nutrition.gov www.fitness.gov www.cdc.gov/tobacco/sgr_tobacco_use.htm

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Relevant Literature, con’t Byers, et al., The Costs and Effects of a Nutritional Education Program Following Work-Site Cholesterol Screening, Am J Pub Hlth. 1995; 85(5): 650-655 Francisco, et al., An experimental evaluation of an incentive program to reduce serum cholesterol levels among health fair participants. Arch of Fam Med. 1994;3(3):246-51 Grundy, et al., Hypertriglyeridemia, insulin resistance, and the metabolic syndrome. Am J Cardiol. 1999 May 13;83(9B):25F-29F Halbert, et al. Exercise training and blood lipids in hyperlipidemic and normolipidemic adults: a meta-analysis. Euro J Clin Nutr, 1999;53(7):514-522 Maiman LA, Hildreth NG, Cox C, Greenland P. Improving referral compliance after public cholesterol screening. Am J Public Health. 1992;82:804-809 Tang, et al. Systemic review of dietary interventions to lower blood cholesterol in free living subjects. BMJ. 1998;316:1213-1219 Wagner, et al., Chronic care clinics for diabetes care in primary care. A system wide randomized trial. Diabetes Care. 2001;24:695-700

Slide 38 :

Aknowledgements Walter Birdsall, MD Don Warner, Support Services Coordinator Henry Ford, CEO Gayle Duet, Hospital Coordinator Les Bourg, LDN, RD Susan Danos, Educational Director

Slide 39 :

Thank You!

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