Transcript of Metabolic Syndrome, Diabetes, and Cardiovascular Disease: Implications for Preventive Cardiology...
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- Metabolic Syndrome, Diabetes, and Cardiovascular Disease:
Implications for Preventive Cardiology Nathan D. Wong, PhD, FACC,
FAHA Professor and Director Heart Disease Prevention Program
Division of Cardiology University of California, Irvine
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- Overview of Diabetes in the United States
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- Diabetes Prevalence, 1990-1998
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- Age-adjusted prevalence of physician-diagnosed diabetes in
Adults age 18 and older by race/ethnicity and sex (NHANES:
1999-2004). Source: NCHS and NHLBI. NH non-Hispanic.
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- Risk of Cardiovascular Events in Diabetics Framingham Study
Age-adjusted Biennial Rate Age-adjusted Per 1000 Risk Ratio
Cardiovascular Event Men Women Men Women Coronary Disease 39 21
1.5** 2.2*** Stroke15 6 2.9*** 2.6*** Peripheral Artery Dis. 18 18
3.4*** 6.4*** Cardiac Failure 23 21 4.4*** 7.8*** All CVD Events 76
65 2.2*** 3.7*** Subjects 35-64 36-year Follow-up **P
- Revised ATP III Metabolic Syndrome Oct 2005 *Diagnosis is
established when 3 of these risk factors are present. Abdominal
obesity is more highly correlated with metabolic risk factors than
is BMI. Some men develop metabolic risk factors when circumference
is only marginally increased. 102 cm (>40 in) >88 cm (>35
in) Men Women 100 mg/dL or Rx for glucose Fasting glucose 130/ 85
mm Hg or on HTN Rx Blood pressure HDL-C 150 mg/dL or Rx for TG TG
Abdominal obesity (Waist circumference ) Defining LevelRisk
Factor
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- International Diabetes Federation Definition: Abdominal obesity
plus two other components: elevated BP, low HDL, elevated TG, or
impaired fasting glucose
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- Prevalence of the Metabolic Syndrome Among US Adults NHANES
1988-1994 Prevalence (%) 0 5 10 15 20 25 30 35 40 45
20-2930-3940-4950-5960-69> 70 Men Women Age (years) Ford E et
al. JAMA. 2002(287):356. 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
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- Prevalence of the NCEP Metabolic Syndrome: NHANES III by Sex
and Race/Ethnicity Prevalence, % Men Ford ES et al. JAMA
2002;287:356-359. Women White African American Mexican American
Other25% 16% 28% 21% 23% 26% 36% 20%
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- Cardiovascular Disease (CVD) and Total Mortality: US Men and
Women Ages 30-74 (age, gender, and risk-factor adjusted Cox
regression) NHANES II Follow- Up (n=6255)(Malik and Wong, et al.,
Circulation 2004; 110: 1245-1250 ) * p