METABOLIC SYNDROME: A GLOBAL PERSPECTIVE Charles Wang, PharmD Candidate.
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Transcript of METABOLIC SYNDROME: A GLOBAL PERSPECTIVE Charles Wang, PharmD Candidate.
METABOLIC SYNDROME:A GLOBAL PERSPECTIVE
Charles Wang, PharmD Candidate
Objectives
Defining Metabolic Syndrome (MetS) Factors leading to Metabolic Syndrome Metabolic Syndrome Around the World Treatment Test
Definition
Metabolic Syndrome goes by many names Metabolic syndrome X Cardiometabolic syndrome Syndrome X Insulin resistance syndrome Reaven’s syndrome (named after Gerald
Reaven) CHAOS (Australian)
Definition
Metabolic Syndrome is a collection of medical disorders that when occur together, increase risk of cardiovascular disease and diabetes.
Incorrectly classified as First World Problem Can occur in any nation, regardless of
wealth All starts with obesity Main culprit is insulin resistance On the rise
Diagnosis
Depends on the organization International Diabetes Federation
Central Obesity (determined by waist circumference) AND two of the following Triglycerides > 150 mg/dL HDL < 40 mg/dL in males <50 mg/dL in
females Systolic >130 or diastolic >85 mmHg FPG > 100 mg/dL
If BMI > 30 kg/m^2 central obesity is assumed
Diagnosis
World Health Organization Diabetes Type 1 or 2, impaired glucose
tolerance, impaired fasting glucose, or insulin resistance, AND two of the following Blood Pressure ≥ 140/90 mmHg Dyslipidemia: TG ≥ 1.695 mmol/L and HDL ≤
0.9 mmol/L male, ≤ 1.0 mmol/L female Central Obesity: waist:hip ratio > 0.9 in males,
> 0.85 in females, or BMI > 30 kg/m^2 Microalbuminuria: excretion ratio ≥ mcg/min or
albumin:creatinine ration ≥ 30 mg/g
Diagnosis
European Group for the Study of Insulin Resistance Requires insulin resistance defined as the top
25% of the fasting insulin values among non-DM AND two or more of the following
Central obesity: waist circumference ≥ 94 cm in males and ≥ 80 cm in females
Dyslipidemia: TG ≥ 2.0 mmol/L and/or HDL < 1
Hypertension: ≥ 140/90 mmHg Fasting plasma glucose ≥ 6.1 mmol/L
Diagnosis
National Cholesterol Education Program ATP III At least 3 of the following
Central obesity: WC ≥ 40 inches in males ≥ 36 in female
Dyslipidemia: TG ≥ 150 mg/dl HDL < 40 in males, < 50 in females
HTN: ≥ 130/85 mmHg Fasting Plasma Glucose ≥ 110
Definition
Diseases that encompass metabolic syndrome Central Obesity Insulin Resistance Hypertension Hyperlipidemia
Australian CHAOS Coronary artery disease Hypertension Adult onset diabetes Obesity Stroke
Central Obesity
Also known as the following Abdominal obesity Belly fat
It is high fat content in the abdominal areas
Excessive Visceral fat (organ fat) Intra-abdominal fat Located inside the peritoneal cavity Packed in between internal organs
Central Obesity
Pathophysiology
Insulin Resistance
Impaired fasting glucose >100 mg/dL Impaired glucose tolerance
> 140 mg/dL for 120 minutes after ingestion of 75 grams of glucose
Elevated homeostatic model assessment of insulin resistance (HOMA-IR) Quantifies insulin resistance and beta-cell
function with formula
Pathophysiology
Dyslipidemia
Atherogenic dyslipidemia High plasma TG Low HDL cholesterol levels Increase in small dense LDL
Pathophysiology
Hypertension
Most important single, modifiable risk factor for stroke and an important risk factor for atherosclerosis and ischemic heart disease
Disease caused by endothelial dysfunction Fails to serve its normal physiological and
protective mechanisms
Pathophysiology
Statistics
As countries “westernize/urbanize” Theory is mankind evolved on limited
nutrition and excess causes fat storage Increased access to food Decreased physical activity
Sedentary lifestyle Diet high carbohydrates Increases in obesity, dyslipidemia,
hypertension, hyperglycemia/diabetes No longer diseases of the wealthy
Metabolic Syndrome Around the World
By 2025, three out of four people with diabetes will be living in third world countries.
United States ~25% have metabolic syndrome as defined by
the WHO 50 million in 1990, 64 million in 2000
India Urbanization has caused an increase in
hypertension in slums and increase risk of diabetes in females with normal BMI (18-25)
~29% of the population have metabolic syndrome
Metabolic Syndrome Around the World
China Overweight 26.9% in men, 31.1% in women 13.2% have metabolic syndrome Higher in northern China than southern Higher in urban residents vs rural Growing rapidly due to aging population
and urbanization
Metabolic Syndrome Around the World
UK Average BMI in 1970s was ~23 Average BMI in 1990s was ~26
Metabolic Syndrome Around the World
Treatment
Lifestyle Changes Lose weight Exercise Follow a heart healthy diet Stop smoking
Pharmacological Interventions Take your meds as prescribed