Metabolic Syndrome PPT | Cardiovascular Disease Risk | Cardiovascular Risk | Diabetes Metabolic Syndrome | Metabolic Syndrome Diagnosis | Metabolic Syndrome Treatment: SlideWorld Medical PPT Search Engine

Metabolic Syndrome: Cardiovascular Risk and Treatment Options

Rating :

Rate It:

Send This

Download

Comment

Favourite

more

Notes

Show Notes

Slide 1 :

Metabolic Syndrome: Cardiovascular Risk and Treatment Options Dr Greg Bondy MD FRCPC Healthy Heart Lipid Clinic St Paul’s Hospital

Slide 2 :

Objectives: Metabolic Syndrome Clinical and biochemical features including ATP III criteria Evaluation of an obese patient CVS risk assessment Treatment options: Obesity, Cardiac protection Model of metabolic syndrome: HIV Lipodystrophy

Slide 3 :

Case History: 47 yr male Dyslipidemia since age 30 (pancreatitis) Six episodes of pancreatitis. EtOH? Diet? CVS risks: ex-smoker (45 pck yrs), normotensive, no diabetes, no exercise Family History: father had MI at 45 Lab (pre-Rx): TC 6.2, TG 9.0, HDL 0.8 FBS 6.2

Slide 4 :

Case History: 47 yr male Weight history: age 30 100 kg age 47 126 “Cannot stop eating” Physical exam: Alert, generalized obesity, prominent obesity. Baseball cap “Acme food processor” BP 145/95 Waist 46”

Slide 5 :

Does this person have the metabolic syndrome?

Slide 6 :

Criteria for Metabolic Syndrome National Cholesterol Education Program (ATP-III): North America. Emphasize vascular risk World Health Organization: Europe. Emphasize insulin resistance, must have abdominal obesity/glucose intolerance

Slide 7 :

Metabolic Syndrome: ATP III Criteria Abdominal obesity men > 102 (40”) women >88 (35”) Blood pressure > 130/85 TG >1.7 mmol/L HDL men < 1.0 mmol/L women < 1.3 mmol/L Fasting glucose >6.1 Metabolic syndrome with three or more features

Slide 8 :

IDF (International Diabetes Federation): Metabolic Syndrome Definition Central Obesity (Men > 94 cm, Women > 80 cm) Plus any two: TG > 1.7 HDL < 0.9 (males), < 1.1 (females) BP > 130/85 FBS > 5.6 or previously diagnosed DM

Slide 9 :

Clinical Skills: Body Fat 1. Direct measurement of body fat Electrical impedance DEXA scans CT/MRI (intra-abdominal fat) 2. Anthropometric measurements 3. Regional fat distribution Waist/hip ratio Waist circumference

Slide 10 :

Abdominal Obesity Men > 102 cm (40”) Women > 88 cm (35”)

Slide 11 :

Body Fat Distribution 1. Central or visceral/abdominal obesity “apple-shape” 2. Gluteal-femoral obesity “pear-shape”

Slide 12 :

Intra-abdominal (visceral) fat: The dangerous inner fat ! Front Back AT: adipose tissue

Slide 13 :

These features can lead to type 2 diabetes, hypertension and cardiovascular disease Visceral obesity is associated with a cluster of metabolic abnormalities Hypertriglyceridemia Low HDL-C Elevated apolipoprotein B Small, dense LDL particles Inflammatory profile Hyperinsulinemia Glucose intolerance Insulin resistance Impaired fibrinolysis Endothelial dysfunction

Slide 14 :

Prevalence of Metabolic Syndrome 20-25% of USA population 40% of individuals over age 60 JAMA 287:356, 2002

Slide 15 :

Metabolic Syndrome/Insulin Resistance: Cardiovascular Risk Increased vascular inflammation Accelerated platelet activity Impaired fibrinolysis

Slide 16 :

Slide 17 :

Metabolic Syndrome and the Risk for Cardiovascular Disease Risk for CVS disease X2-4 fold Calculate10-yr risk using Framingham risk scores: double the score if patient has the metabolic syndrome

Slide 18 :

Apo B and LDL-cholesterol NOTE: apo B level does not correlate with serum triglyceride level LDL LDL-C 3.0 mmol/L LDL LDL apo B 0.8 g/L LDL LDL LDL LDL LDL LDL LDL-C 3.0 mmol/L apo B 1.6 g/L apo B apo B Sample a Sample b

Slide 19 :

Apolipoprotein B Better predictor of CVS risk Better predictor of response to statins Analytical: 3-4% CV, robust methods, non-fasting samples, Triglycerides up to 10 mmol/l Goal: Apo B < 0.9 (high risk) Apo B < 1.2 (low risk)

Slide 20 :

Treatment of the metabolic syndrome Recognize the syndrome Weight reduction: exercise and diet. Drug therapy? Diabetes prevention CVS protection: lipid lowering, BP control

Slide 21 :

Diabetes Prevention: Medications vs Lifestyle Diabetes Prevention Program Research Group NEJM 346:393, 2002 3,234 patients at risk for type 2 DM Treatments: placebo vs lifestyle vs metformin 2.8 yrs follow-up Diabetes prevention: 58% by lifestyle, 31% by metformin

Slide 22 :

Aims: Does ramipril 15 mg/d prevent diabetes? Does rosiglitazone 8 mg/d prevent diabetes? Design: 2 X 2 factorial, double-blind RCT Sample: IGT (FPG <7 & 2 hr 7.8-11) &/or IFG (FPG 6.1-6.9) Pts: 5269 in 191 sites, 21 countries, & F/U 3 yrs Outcome: Incident DM (confirmed FPG > 7 or 2 hr > 11.1; or MD diagnosis) or death* The DREAM Trial

Slide 23 :

Slide 24 :

Anti-Obesity Drugs 1. Appetite (Satiety) Suppressant Drugs Sibutramine Cannibinoid receptor blockers 2. Nutrient absorption blockers Orlistat (fat absorption)

Slide 25 :

Anti-Obesity Drugs (continued) 3. Thermogenic agents Thyroid hormone Amphetamine/cocaine Nicotine 4. Increased lean body mass Androgens, growth hormone Resistance exercise

Slide 26 :

Indications for Anti-obesity Drugs Diabetes (type 2) Hypertriglyceridemia (+/-) pancreatitis Metabolic syndrome CPS indications: BMI > 30 BMI > 27 (with risk factors)

Slide 27 :

Metabolic Syndrome: Obesity Treatment vs Vascular Protection

Slide 28 :

Metabolic Syndrome: Vascular Protection Lipid Management Control of Hypertension Anti-platelet therapy (ASA) Smoking cessation Glycemic control Lifestyle

Slide 29 :

Lipid lowering therapy for the metabolic syndrome: statins versus fibrates Unanswered question. We require trials in this area.

Slide 30 :

HIV Lipodystrophy Syndrome Alterations in body fat composition loss of sc fat in face, arms, legs, and gluteal region fat deposition in abdomen (omental fat) and cervical hump Metabolic Disorders dyslipidemia glucose intolerance bone loss

Slide 31 :

Highly Active Antiretroviral Therapy (HAART) Combination Drug therapy: inhibitor of HIV-1 protease (PI) + 2 reverse transcriptase inhibitors (RTI’S) RTI’S: Nucleoside-analogue (NRTI’S) Non-Nucleosides (NNRTI’S)

Slide 32 :

Case History: HIV Dyslipidemia 53 yr male. HIV + September/98: 9-drug anti-retroviral regime June/99: TC=18.3 mmol/L TG= 63.8 HDL=0.50 No abdominal pain, no skin lesions Rx: atorvostatin 20 mg, micronized fenofibrate 200 mg Diet: 1/2 lb butter/day, 6 eggs/day July/99 TC=5.1, LDL=1.95, HDL=1.21 TG=4.1

Slide 33 :

HIV Dyslipidemias Dyslipidemias associated with protease inhibitors Elevated TG (X2-X50) Elevated Total Cholesterol Decreased HDL

Slide 34 :

Do patients with the lipodystrophy syndrome have increased risk for cardiovascular disease?

Slide 35 :

D:A:D Study Risk Ratio 0.32 1 1.52 1.64 2.01 2.45 2.51 2.93 Cumulative CVD Risk With Duration of Exposure Friis-Møller N et al. AIDS 2003 23:1179-1193.

Slide 36 :

Slide 37 :

Summary Metabolic Syndrome/Obesity is a growing problem CVS risk associated with metabolic syndrome Medical treatment: Obesity Cardiac protection

There is no comments now for this Slide.

Post a comment

Post Comment on Twitter Post Comment on SlideWorld

Comments:

Subscribe to follow-up comments

1 Favorites

stepmatt, favourited this 2 Months ago.

	SlidesOnline 1 Years ago. Category: other

Tags:	other

862 Views, 2 favourite
Apo B and LDL-cholesterol. NOTE: apo B level does not correlate with serum .... Even in the presenc more Apo B and LDL-cholesterol. NOTE: apo B level does not correlate with serum .... Even in the presence of normal LDL-C levels, apo B will be up 25%, … less

SWINE Flu

Why do women live longer then men? Humor

History of Medicine

Yoga and Medicine

How to be a Successful Interventional Fellow size 50 MB

Cardiac Pathology

Hypertension: New Concepts, Guidelines, and Clinical Management

Diabetes Pathology