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Cardiometabolic Syndrome Nabil Sulaiman HOD Family and Community
Cardiometabolic Syndrome Nabil Sulaiman HOD Family and Community
Cardiometabolic Syndrome II Aims
Cardiometabolic Syndrome II Aims
Clustering of Components:
Clustering of Components:
Global cardiometabolic risk*
Global cardiometabolic risk*
International Diabetes Federation (IDF) Consensus Definition 2005
International Diabetes Federation (IDF) Consensus Definition 2005
Why a New Definition of the MeS: IDF Objectives
Why a New Definition of the MeS: IDF Objectives
Central Obesity
Central Obesity
Fat Topography In Type 2 Diabetic Subjects
Fat Topography In Type 2 Diabetic Subjects
Abdominal obesity and increased risk of cardiovascular events
Abdominal obesity and increased risk of cardiovascular events
Abdominal obesity increases the risk of developing type 2 diabetes
Abdominal obesity increases the risk of developing type 2 diabetes
Abdominal obesity is linked to an increased risk of coronary heart
Abdominal obesity is linked to an increased risk of coronary heart
Diabetes
Diabetes
OBESITY
OBESITY
DIAB ESITY
DIAB ESITY
Targeting Cardiometabolic Risk
Targeting Cardiometabolic Risk
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 a major contributor to increased
Intra-abdominal adiposity is a major contributor to increased
Waist Circumference
Waist Circumference
Intra-abdominal adiposity and dyslipidaemia
Intra-abdominal adiposity and dyslipidaemia
Insulin Resistance: Associated Conditions
Insulin Resistance: Associated Conditions
Targeting Cardiometaboilc Risk Defining cardiometabolic Risk
Targeting Cardiometaboilc Risk Defining cardiometabolic Risk
Targeting Cardiometaboilc Risk Defining cardiometabolic Risk
Targeting Cardiometaboilc Risk Defining cardiometabolic Risk
Linked Metabolic Abnormalities:
Linked Metabolic Abnormalities:
Resulting Clinical Conditions:
Resulting Clinical Conditions:
Targeting Cardiometaboilc Risk
Targeting Cardiometaboilc Risk
Multiple Risk Factor Management
Multiple Risk Factor Management
Glucose Abnormalities:
Glucose Abnormalities:
Hypertension:
Hypertension:
Dyslipidemia:
Dyslipidemia:
Insulin Resistance:
Insulin Resistance:
Public Health Approach
Public Health Approach
Screening/Public Health Approach
Screening/Public Health Approach
Exercise Improves CV fitness, weight control, sensitivity to insulin,
Exercise Improves CV fitness, weight control, sensitivity to insulin,
Smoking Cessation / Avoidance:
Smoking Cessation / Avoidance:
Diabetes Control - How Important
Diabetes Control - How Important
Lifestyle modification
Lifestyle modification
Overcome Insulin Resistance/ Diabetes:
Overcome Insulin Resistance/ Diabetes:
Insulin
Insulin
BP Control - How Important
BP Control - How Important
Lipid Control - How Important
Lipid Control - How Important
Substantial residual cardiovascular risk in statin-treated patients
Substantial residual cardiovascular risk in statin-treated patients
Medications:
Medications:
Cardiometabolic Syndrome Nabil Sulaiman HOD Family and Community
Cardiometabolic Syndrome Nabil Sulaiman HOD Family and Community
Antihypertensive Medications:
Antihypertensive Medications:
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
Individual metabolic abnormalities among Qatari population according
Individual metabolic abnormalities among Qatari population according
Individual metabolic abnormalities among Qatari population according
Individual metabolic abnormalities among Qatari population according
Prevalence of MeS in different Countries
Prevalence of MeS in different Countries
Is it a Syndrome
Is it a Syndrome
A Critical Look at the Metabolic Syndrome
A Critical Look at the Metabolic Syndrome
A Critical Look at the Metabolic Syndrome
A Critical Look at the Metabolic Syndrome
Insulin Resistance: Associated Conditions
Insulin Resistance: Associated Conditions
Thank You
Thank You
Cardiometabolic Syndrome Nabil Sulaiman HOD Family and Community
Cardiometabolic Syndrome Nabil Sulaiman HOD Family and Community
Determinants and dynamics of the CVD Epidemic in the developing
Determinants and dynamics of the CVD Epidemic in the developing
Determinants and dynamics of the CVD epidemic in the developing
Determinants and dynamics of the CVD epidemic in the developing
CVD epidemic in developing & developed countries
CVD epidemic in developing & developed countries
Coronary heart disease Mortality statistics Specific mortality data
Coronary heart disease Mortality statistics Specific mortality data
Central obesity: a driving force for cardiovascular disease & diabetes
Central obesity: a driving force for cardiovascular disease & diabetes
Why people physically inactive
Why people physically inactive
Insulin Resistance: Associated Conditions
Insulin Resistance: Associated Conditions
Prevalence of the Metabolic Syndrome Among US Adults NHANES 1988-1994
Prevalence of the Metabolic Syndrome Among US Adults NHANES 1988-1994
Cardiometabolic Syndrome Nabil Sulaiman HOD Family and Community
Cardiometabolic Syndrome Nabil Sulaiman HOD Family and Community
Prevention of CVD
Prevention of CVD
International Diabetes Federation (IDF) Consensus Definition 2005
International Diabetes Federation (IDF) Consensus Definition 2005
International Diabetes Federation (IDF) Consensus Definition 2005
International Diabetes Federation (IDF) Consensus Definition 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
Summary: new IDF definition for the Metabolic Syndrome
Summary: new IDF definition for the Metabolic Syndrome
Cardiometabolic Syndrome Nabil Sulaiman HOD Family and Community
Cardiometabolic Syndrome Nabil Sulaiman HOD Family and Community

Презентация: «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». Автор: Nabil. Файл: «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». Размер zip-архива: 2383 КБ.

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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1 Cardiometabolic Syndrome Nabil Sulaiman HOD Family and Community

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

2 Cardiometabolic Syndrome II Aims

Cardiometabolic Syndrome II Aims

Abdominal obesity prevalence Targeting Cardiometabolic Risk factors Multiple Risk Factor management A Critical Look at the Metabolic Syndrome

3 Clustering of Components:

Clustering of Components:

Hypertension: BP. > 140/90 Dyslipidemia: TG > 150 mg/ dL ( 1.7 mmol/L ) HDL- C < 35 mg/ dL (0.9 mmol/L) Obesity (central): BMI > 30 kg/M2 Waist girth > 94 cm (37 inch) Waist/Hip ratio > 0.9 Impaired Glucose Handling: IR , IGT or DM FPG > 110 mg/dL (6.1mmol/L) 2hr.PG >200 mg/dL(11.1mmol/L) Microalbuninuria (WHO)

4 Global cardiometabolic risk*

Global cardiometabolic risk*

Gelfand EV et al, 2006; Vasudevan AR et al, 2005

* working definition

5 International Diabetes Federation (IDF) Consensus Definition 2005

International Diabetes Federation (IDF) Consensus Definition 2005

The new IDF definition focusses on abdominal obesity rather than insulin resistance

6 Why a New Definition of the MeS: IDF Objectives

Why a New Definition of the MeS: IDF Objectives

Needs: To identify individuals at high risk of developing cardiovascular disease (and diabetes) To be useful for clinicians To be useful for international comparisons

7 Central Obesity

Central Obesity

IDF: Central obesity - waist circumference >94 cm for Europid men, >80 Europid women with ethnicity specific values for other groups WHO: Waist-hip ratio >0.9 - men or >0.85 - women ATP III: Waist circumference >40 in. - men, > 35 in. - women

8 Fat Topography In Type 2 Diabetic Subjects

Fat Topography In Type 2 Diabetic Subjects

Intramuscular

Subcutaneous

Intrahepatic

Intra- abdominal

9 Abdominal obesity and increased risk of cardiovascular events

Abdominal obesity and increased risk of cardiovascular events

The HOPE study

1.4

1.2

Adjusted relative risk

1

0.8

1.35

1.29

1.27

1.17

1.16

1.14

1

1

1

CVD death

MI

All-cause deaths

Adjusted for BMI, age, smoking, sex, CVD disease, DM, HDL-cholesterol, total-C; CVD: cardiovascular disease; MI: myocardial infarction; BMI: body mass index; DM: diabetes mellitus; HDL: high-density lipoprotein cholesterol

Men

Women

Tertile 1

<95

<87

Waist circumference (cm):

Tertile 2

95–103

87–98

Tertile 3

>103

>98

Dagenais GR et al, 2005

10 Abdominal obesity increases the risk of developing type 2 diabetes

Abdominal obesity increases the risk of developing type 2 diabetes

24

20

16

12

8

4

0

Relative risk

Waist circumference (cm)

<71

71–75.9

76–81

81.1–86

86.1–91

91.1–96.3

>96.3

Carey VJ et al, 1997

11 Abdominal obesity is linked to an increased risk of coronary heart

Abdominal obesity is linked to an increased risk of coronary heart

disease

Waist circumference has been shown to be independently associated with increased age-adjusted risk of CHD, even after adjusting for BMI and other cardiovascular risk factors

CHD: coronary heart disease; BMI: body mass index

Rexrode KM et al, 1998

12 Diabetes

Diabetes

Diabetes in the new millennium Interdisciplinary problem

13 OBESITY

OBESITY

Diabetes in the new millennium Interdisciplinary problem

14 DIAB ESITY

DIAB ESITY

Diabetes in the new millennium Interdisciplinary problem

15 Targeting Cardiometabolic Risk

Targeting Cardiometabolic Risk

16 Central obesity: a driving force for cardiovascular disease & diabetes

Central obesity: a driving force for cardiovascular disease & diabetes

“Balzac” by Rodin

Front

Back

17 Intra-abdominal adiposity is closely correlated with abdominal obesity

Intra-abdominal adiposity is closely correlated with abdominal obesity

300

r = 0.80

200

IAA (cm2)

100

IAA

0

60

80

100

120

Waist circumference (cm)

To assess IAA, the simplest measure of abdominal obesity is waist circumference, which is strongly correlated with direct measurement of IAA by CT scan or MRI, considered to be the gold standard

IAA: intra-abdominal adiposity; CT: computed tomography; MRI: magnetic resonance imaging

Despr?s JP et al, 2001; Pouliot MC et al, 2004

18 Intra-abdominal adiposity is a major contributor to increased

Intra-abdominal adiposity is a major contributor to increased

cardiometabolic risk

IAA = high risk fat

Increased cardiometabolic risk

Dyslipidaemia

Insulin resistance

Inflammation

IAA: intra-abdominal adiposity

Kershaw EE et al, 2004; Lee YH et al, 2005; Boden G et al, 2002

19 Waist Circumference

Waist Circumference

20 Intra-abdominal adiposity and dyslipidaemia

Intra-abdominal adiposity and dyslipidaemia

Triglycerides

HDL-cholesterol

310

60

248

186

mg/dL

mg/dL

45

124

62

30

0

Low

High

Lean

Low

High

Lean

Visceral fat (obese subjects)

Visceral fat (obese subjects)

HDL: high-density lipoprotein

Pouliot MC et al, 1992

21 Insulin Resistance: Associated Conditions

Insulin Resistance: Associated Conditions

22 Targeting Cardiometaboilc Risk Defining cardiometabolic Risk

Targeting Cardiometaboilc Risk Defining cardiometabolic Risk

Cardiovascular Disease Abdominal Obesity Glucose intolerance Insulin Resistance Dyslipedemia Hypertension

23 Targeting Cardiometaboilc Risk Defining cardiometabolic Risk

Targeting Cardiometaboilc Risk Defining cardiometabolic Risk

Major Unmet Clinical Need Classical Risk Factors Novel Risk Factors Cluster Risk Factors LDL-C BP Smoking DM-2 Insulin HDL-C TNF & IL-6 Abdominal Obesity Glucose PAI-1 TG Cardiovascular Disease

24 Linked Metabolic Abnormalities:

Linked Metabolic Abnormalities:

Impaired glucose handling/ insulin resistance Atherogenic dyslipidemia Endothelial dysfunction Prothrombotic state Hemodynamic changes Proinflammatory state Excess ovarian testosterone production Sleep-disordered breathing

25 Resulting Clinical Conditions:

Resulting Clinical Conditions:

Type 2 diabetes Essential hypertension Polycystic ovary syndrome (PCOS) Nonalcoholic fatty liver disease Sleep apnea Cardiovascular Disease (MI, PVD, Stroke) Cancer (Breast, Prostate, Colorectal, Liver)

26 Targeting Cardiometaboilc Risk

Targeting Cardiometaboilc Risk

Site of Action Mechanisms Addresses Adipose tissues Adiponectin Dyslipidemia Lipogeenesis Insulin resistance Muscle G uptake Insulin resistance Liver Lipogeenesis Dyslipidemia Insulin resistance GI tract Satiety signals Body weight Waist circumference Hypothalamus Food intake Body weight Waist circumference Genetic?

27 Multiple Risk Factor Management

Multiple Risk Factor Management

Obesity Glucose Intolerance Insulin Resistance Lipid Disorders Hypertension Goals: Minimize Risk of Type 2 Diabetes and Cardiovascular Disease

28 Glucose Abnormalities:

Glucose Abnormalities:

IDF: FPG >100 mg/dL (5.6 mmol. L) or previously diagnosed type 2 diabetes (ADA: FBS >100 mg/dL [ 5.6 mmol/L ])

29 Hypertension:

Hypertension:

IDF: BP >130/85 or on Rx for previously diagnosed hypertension

30 Dyslipidemia:

Dyslipidemia:

IDF: Triglycerides - >150mg/dL (1.7 mmol /L) HDL - <40 mg/dL (men), <50 mg/dL (women)

31 Insulin Resistance:

Insulin Resistance:

Hyperinsulinemic individuals are at risk for developing Diabetes, Dyslipidemia, Hypertension & ultimately Cardiovascular disease Patients with Metabolic Syndrome are 3.5 times as likely to die from Cardiovascular disease compared to normal people

32 Public Health Approach

Public Health Approach

33 Screening/Public Health Approach

Screening/Public Health Approach

Public Education Screening for at risk individuals: Blood Sugar/ HbA1c Lipids Blood pressure Tobacco use Body habitus Family history

34 Exercise Improves CV fitness, weight control, sensitivity to insulin,

Exercise Improves CV fitness, weight control, sensitivity to insulin,

reduces incidence of diabetes Weight loss Improves lipids, insulin sensitivity, BP levels, reduces incidence of diabetes Goals: Brisk walking - 30 min./day 10% reduction in body wt.

Life-Style Modification: Is it Important?

35 Smoking Cessation / Avoidance:

Smoking Cessation / Avoidance:

A risk factor for development in children and adults Both passive and active exposure harmful A major risk factor for: insulin resistance and metabolic syndrome macrovascular disease (PVD, MI, Stroke) microvascular complications of diabetes pulmonary disease, etc.

36 Diabetes Control - How Important

Diabetes Control - How Important

Goals: FBS - premeal <110, postmeal <180. HbA1c <7% For every 1% rise in Hb A1c there is an 18% rise in risk of cardiovascular events & a 28% increase in peripheral arterial disease Evidence is accumulating to show that tight blood sugar control in both Type 1 and Type 2 diabetes reduces risk of CVD

37 Lifestyle modification

Lifestyle modification

If a 1% reduction in HbA1c is achieved, you could expect a reduction in risk of: 21% for any diabetes-related endpoint 37% for microvascular complications 14% for myocardial infarction

Diet Exercise Weight loss Smoking cessation

However, compliance is poor and most patients will require oral pharmacotherapy within a few years of diagnosis

Stratton IM et al. BMJ 2000; 321: 405–412.

38 Overcome Insulin Resistance/ Diabetes:

Overcome Insulin Resistance/ Diabetes:

Insulin Sensitizers: Biguanides – metformin Glitazones, Gltazars Can be used in combination Insulin Secretagogues: Sulfonylurea - glipizide, glyburide, glimeparide, glibenclamide Meglitinides - repaglanide, netiglamide

39 Insulin

Insulin

Insulin Analogues: Lyspro /Aspart /glulysine used with meals Glargine & Livemer as basal insulin Continuous Subcutaneous Insulin Infusion (CSII) NPH/Regular, NPH/logs - Mixed or in fixed combinations (70/30, 75/25, 50/50) Insulin combined with oral agents

40 BP Control - How Important

BP Control - How Important

Goal: BP.<130/80 MRFIT and Framingham Heart Studies: Conclusively proved the increased risk of CVD with long-term sustained hypertension Demonstrated a 10 year risk of cardiovascular disease in treated patients vs non-treated patients to be 0.40. 40% reduction in stroke with control of HTN Precedes literature on Metabolic Syndrome

41 Lipid Control - How Important

Lipid Control - How Important

Goals: HDL >40 mg% (>1.1 mmol /l) LDL <100 mg/dL (<3.0 mmol /l) TG <150 mg% (<1.7 mmol /l) Multiple major studies show 24 - 37% reductions in cardiovascular disease risk with use of statins and fibrates in the control of hyperlipidemia.

42 Substantial residual cardiovascular risk in statin-treated patients

Substantial residual cardiovascular risk in statin-treated patients

The MRC/BHF Heart Protection Study

30

20

Risk reduction=24% (p<0.0001)

19.8% of statin-treated patients had a major cardiovascular event by 5 years

% patients

10

0

0

1

2

3

4

5

6

Year of follow-up

Placebo Statin

Heart Protection Study Collaborative Group, 2002

43 Medications:

Medications:

Hypertension: ACE inhibitors, ARBs Others - thiazides, calcium channel blockers, beta blockers, alpha blockers Central acting Alfa agonist : Moxolidin Dylipidemia: Statins, Fibrates, Niacin Platelet inhibitors: ASA, clopidogrel

44 Cardiometabolic Syndrome Nabil Sulaiman HOD Family and Community
45 Antihypertensive Medications:

Antihypertensive Medications:

Target BP: <130/80 Angiotensin -converting Enzyme Inhibitors (ACEI) Angiotensin II Receptor (ARB) Blockers Combination with Thiazides, Calcium Channel Blockers, Cardioselective Beta Blockers

46 Cardiometabolic Syndrome Nabil Sulaiman HOD Family and Community
47 Cardiometabolic Syndrome Nabil Sulaiman HOD Family and Community
48 Individual metabolic abnormalities among Qatari population according

Individual metabolic abnormalities among Qatari population according

to gender (Musallam et al 08)

Men (n = 405) Women (n=412) Variable n(%) n(%) p-Value ATP III Abdominal obesity 227(56.0) 308(74.8) <0.001 Hypertension 143(35.3) 156(37.9) 0.448 Diabetes 77(19.0) 107(26.0) 0.017 Hypertriglyceridemia 113(27.9) 83(20.1) 0.009 Low HDL 95(23.5) 121(29.4) 0.055

49 Individual metabolic abnormalities among Qatari population according

Individual metabolic abnormalities among Qatari population according

to gender

No of components of ATP III

Men (n = 405) Women (n=412) Variable n(%) n(%) p-Value None 88(21.7) 74(18.0) – One 103(25.4) 100(24.3) 0.033 Two 125(30.9) 111(26.9) – Three or more 89(22.0) 127(30.8) –

50 Prevalence of MeS in different Countries

Prevalence of MeS in different Countries

Country

Year

Sample

Prevalence (%)

Arab Americans

2003

542

23

Oman

2001

1419

21

Jordan

2002

1121

36

Saudi Arabia

2004

2250

20.8

Palestine

1998

17*

Qatar

2007

817

27.6

Turkey

2004

1637

33.4*

Iran

?

10368

33.7

* Crude rates Mussallam et al. Int J Food Safety and PH 2008

51 Is it a Syndrome

Is it a Syndrome

* “…too much clinically important information is missing to warrant its designations as a syndrome.” Unclear pathogenesis, Insulin resistance is not a consistent finding in some definitions. CVD risks has not shown to be greater than the sum of it’s individual components. *ADA

A Critical Look at the Metabolic Syndrome

52 A Critical Look at the Metabolic Syndrome

A Critical Look at the Metabolic Syndrome

Research “Until much needed research is completed, clinicians should evaluate and treat all CVD risk factors without regard to whether a patient meets the criteria for diagnosis of the ‘metabolic syndrome’.”

53 A Critical Look at the Metabolic Syndrome

A Critical Look at the Metabolic Syndrome

Lifestyle The advice remains to treat individual risk factors when present & to prescribe therapeutic lifestyle changes & weight management for obese patients with multiple risk factors.

54 Insulin Resistance: Associated Conditions

Insulin Resistance: Associated Conditions

55 Thank You

Thank You

56 Cardiometabolic Syndrome Nabil Sulaiman HOD Family and Community
57 Determinants and dynamics of the CVD Epidemic in the developing

Determinants and dynamics of the CVD Epidemic in the developing

Countries

Data from South Asian Immigrant studies Excess, early, and extensive CHD in persons of South Asian origin The excess mortality has not been fully explained by the major conventional risk factors. Diabetes mellitus and impaired glucose tolerance highly prevalent. (Reddy KS, circ 1998). Central obesity, ?triglycerides, ?HDL with or without glucose intolerance, characterize a phenotype. genetic factors predispose to ?lipoprotein(a) levels, the central obesity/glucose intolerance/dyslipidemia complex collectively labeled as the “metabolic syndrome”

58 Determinants and dynamics of the CVD epidemic in the developing

Determinants and dynamics of the CVD epidemic in the developing

countries

Other Possible factors Relationship between early life characteristics and susceptibility to NCD in adult hood ( Barker’s hypothesis) (Baker DJP,BMJ,1993) Low birth weight associated with increased CVD Poor infant growth and CVD relation Genetic–environment interactions (Enas EA, Clin. Cardiol. 1995; 18: 131–5) Amplification of expression of risk to some environmental changes esp. South Asian population) Thrifty gene (e.g. in South Asians)

59 CVD epidemic in developing & developed countries

CVD epidemic in developing & developed countries

Are they same?

Urban populations have higher levels of CVD risk factors related to diet and physical activity (overweight, hypertension, dyslipidaemia and diabetes) Tobacco consumption is more widely prevalent in rural population The social gradient will reverse as the epidemics mature. The poor will become progressively vulnerable to the ravages of these diseases and will have little access to the expensive and technology-curative care. The scarce societal resources to the treatment of these disorders dangerously depletes the resources available for the ‘unfinished agenda’ of infectious and nutritional disorders that almost exclusively afflict the poor

60 Coronary heart disease Mortality statistics Specific mortality data

Coronary heart disease Mortality statistics Specific mortality data

ideal for making comparisons with other countries are not available Inadequate and inappropriate death certification, and multiple concurrent causes of death

Burden of CVD in Pakistan

61 Central obesity: a driving force for cardiovascular disease & diabetes

Central obesity: a driving force for cardiovascular disease & diabetes

“Balzac” by Rodin

Front

Back

62 Why people physically inactive

Why people physically inactive

Lack of awareness regarding the of physical activity for health fitness and prevention of diseases Social values and traditions regarding physical exercise (women, restriction). Non-availability public places suitable for physical activity (walking and cycling path, gymnasium). Modernization of life that reduce physical activity (sedentary life, TV, Computers, tel, cars).

63 Insulin Resistance: Associated Conditions

Insulin Resistance: Associated Conditions

64 Prevalence of the Metabolic Syndrome Among US Adults NHANES 1988-1994

Prevalence of the Metabolic Syndrome Among US Adults NHANES 1988-1994

1999-2002 Prevalence by IDF vs. NCEP Definitions (Ford ES, Diabetes Care 2005; 28: 2745-9) (unadjusted, age 20+) NCEP : 33.7% in men and 35.4% in women IDF: 39.9% in men and 38.1% in women

Age (years)

Ford E et al. JAMA. 2002(287):356.

65 Cardiometabolic Syndrome Nabil Sulaiman HOD Family and Community
66 Prevention of CVD

Prevention of CVD

There is an urgent need to establish appropriate research studies, increase awareness of the CVD burden, and develop preventive strategies. Prevention and treatment strategies that have been proven to be effective in developed countries should be adapted for developing countries. Prevention is the best option as an approach to reduce CVD burden. Do we know enough to prevent this CVD Epidemic in the first place.

67 International Diabetes Federation (IDF) Consensus Definition 2005

International Diabetes Federation (IDF) Consensus Definition 2005

The new IDF definition focusses on abdominal obesity rather than insulin resistance

68 International Diabetes Federation (IDF) Consensus Definition 2005

International Diabetes Federation (IDF) Consensus Definition 2005

Central Obesity

Central Obesity

Waist circumference – ethnicity specific* – for Europids: Male > 94 cm Female > 80 cm

Waist circumference – ethnicity specific* – for Europids: Male > 94 cm Female > 80 cm

plus any two of the following:

plus any two of the following:

Raised triglycerides

> 150 mg/dL (1.7 mmol/L) or specific treatment for this lipid abnormality

Reduced HDL cholesterol

< 40 mg/dL (1.03 mmol/L) in males < 50 mg/dL (1.29 mmol/L) in females or specific treatment for this lipid abnormality

Raised blood pressure

Systolic : > 130 mmHg or Diastolic: > 85 mmHg or Treatment of previously diagnosed hypertension

Raised fasting plasma glucose

Fasting plasma glucose > 100 mg/dL (5.6 mmol/L) or Previously diagnosed type 2 diabetes If above 5.6 mmol/L or 100 mg/dL, OGTT is strongly recommended but is not necessary to define presence of the syndrome.

69 Treatment of Metabolic Syndrome: 2005

Treatment of Metabolic Syndrome: 2005

70 Recommendations for treatment

Recommendations for treatment

Primary management for the Metabolic Syndrome is healthy lifestyle promotion. This includes: moderate calorie restriction (to achieve a 5-10% loss of body weight in the first year) moderate increases in physical activity change dietary composition to reduce saturated fat and total intake, increase fibre and, if appropriate, reduce salt intake.

71 Management of the Metabolic Syndrome

Management of the Metabolic Syndrome

Appropriate & aggressive therapy is essential for reducing patient risk of cardiovascular disease Lifestyle measures should be the first action Pharmacotherapy should have beneficial effects on Glucose intolerance/diabetes Obesity Hypertension Dyslipidaemia Ideally, treatment should address all of the components of the syndrome and not the individual components

72 Summary: new IDF definition for the Metabolic Syndrome

Summary: new IDF definition for the Metabolic Syndrome

The new IDF definition addresses both clinical and research needs: provides a simple entry point for primary care physicians to diagnose the Metabolic Syndrome providing an accessible, diagnostic tool suitable for worldwide use, taking into account ethnic differences establishing a comprehensive ‘platinum standard’ list of additional criteria that should be included in epidemiological studies and other research into the Metabolic Syndrome

73 Cardiometabolic Syndrome Nabil Sulaiman HOD Family and Community
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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