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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