METABOLIC SYNDROME:A GLOBAL PERSPECTIVECharles 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