The  Wxyz Of Cardiodiab Risk
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The Wxyz Of Cardiodiab Risk

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A CONCISE AND BRIEF REVIEW ON THE VARIOUS CVD RISK FACTORS OF DIABETIC INDIVIDUALS

A CONCISE AND BRIEF REVIEW ON THE VARIOUS CVD RISK FACTORS OF DIABETIC INDIVIDUALS

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  • 1. THE WXYZ OF CARDIODIAB RISK DR.RISHIKESAN K.V VENNIYIL MED .CENTRE SHARJAH
  • 2.  
  • 3. DIABETES EPIDEMIC
  • 4.  
  • 5.  
  • 6.  
  • 7.  
  • 8. EARLY RECOGNITION OF RISK FACTORS
    • ENABLES THE CONTROL OF THE PROGRESSION OF THESE FACTORS BY LIFE STYLE CHANGE AND OR MEDICATIONS
    • LIFE STYLE CHANGES TARGET WEIGHT LOSS AND INCREASED PHYSICAL ACTIVITY
  • 9.  
  • 10.  
  • 11. THE MNEMONIC WXYZ
    • W = THE WEIGHT/WAIST FACTOR
    • X = THE METABOLIC SYNDROME (SYNDROME X ) ASSOCIATED WITH CENTRAL OVERWT.
    • Y = WHY THE PARTICULAR PERSON DEVELOPS THE METABOLIC SYNDROME
    • Z = SLEEP APNOEA, NOT GETTING ENOUGH SLEEP
  • 12. W – THE WEIGHT/WAIST FACTOR
    • EACH YEAR OUR WEIGHT AND WAIST
    • GET BIGGER BOTH AS INDIVIDUALS
    • AND AS A POPULATION.
    • THERE ARE MANY FACTORS – BUT THE
    • BIG TWO ARE _ HIGH ENERGY FOOD
    • _ LOW ENERGY LIFE
    • STYLE
  • 13.  
  • 14.  
  • 15. FACTORS INCREASING WT.&WAIST
    • THE BIG TWO
    • * EATING MORE
    • * WALKING LESS
    • POSSIBLE OTHER FACTORS
    • *NOT ENOUGH SLEEP
    • *CLIMATE CONTROL
    • *LESS SMOKING
    • *MEDICATIONS
    • *MATURE MUMS
    • *PRENATAL EFFCTS
    • *POLLUTION
    • *LIKE MARRYING LIKE
    • *FAT EQUALS FECUND
  • 16.  
  • 17.  
  • 18. GLOBESITY
    • Obesity is becoming a global problem.
    • The prevalence of obesity is increasing in Europe, Japan, & China .
    • 10% of Chinese children are obese.
  • 19.  
  • 20. W FACTOR
    • MEN AND WOMEN ARE GETTING HEAVIER AND FATTER
    • WOMEN ARE GAINING .6 KG PER EVERY YEAR AND MEN GAIN .4 KG PER YEAR.
    • THIS W FACTOR CAN BE ASSESSED BY WAIST CIRCUMFERENCE.
    • > 88 CM. FOR WOMEN; > 102 CM FOR MEN
  • 21.  
  • 22. Teleology
    • Early humans evolved powerful mechanisms for storing & saving energy.
    • They ate as much as possible when they had the chance, stored it as fat. They were energy efficient.
  • 23. We Are Victims Of Our Success
    • We still possess the adaptive traits of our Paleolithic ancestors. We are programmed to eat as much as we can & store it as fat. We are still energy efficient. If we had not developed these traits we would have become extinct,
    • but we have changed our environment!
  • 24. Why Have We Gained So Much Weight?
    • The current epidemic of obesity is not an epidemic of lack of character.
    • Obesity is a “complex multifactorial chronic disease that develops from an interaction of genotype & environment…it involves the integration of social, behavioral, cultural, physiologic, metabolic & genetic factors”
  • 25. Starvation Is No Longer A Threat
    • We can produce large quantities of cheap, convenient, tasty, high calorie food
    • We are extremely good at marketing this food to adults and to children .
  • 26. THE BIG TWO
    • THE BIG TWO OF – HIGH ENERGY FOOD AND LOW ENERGY LIFE STYLE: FOR Eg :FAST FOOD , TELEVISION AND COMPUTER
    • WE LIVE IN AN ENVIRONMENT DISPOSING TOWARDS OBESITY
    • HEALTHY LIFESTYLE CHOICES ARE HARD CHOICES
  • 27. We Don’t Have To Expend Much Energy
    • We have created conditions that allow us to avoid exertion at work, in travel, & in entertainment.
    • We do little to promote exercise at school or in our communities.
  • 28. Our Diet Has Changed
    • There are more two wage earner families & less time to cook food at home.
    • We eat more fast food.
    • Fast food has been heavily marketed to children.
  • 29. OTHER SYSTEMATIC FACTORS LEADING TO WT. GAIN
    • SMOKING LESS AND SLEEPING LESS
    • SEEM TO PREDISPOSE TO WT.GAIN
    • THE SUCCESS OF QUIT CAMPAIGN MAY
    • BE AT THE PRICE OF A FATTER
    • POPULATION IN MANY COUNTRIES
  • 30. *Heating and Airconditioning in homes and workplaces have reduced the need for body energy expenditure to keep warm or cold. *Overwt.people tend to have overwt.children
  • 31. * WOMEN ARE DELAYING HAVING CHILDREN AND OLDER MOTHERS TEND TO HAVE FATTER CHILDREN
  • 32. * PEOPLE TEND TO BE ATTRACTED TO THOSE WHO ARE LIKE THEM
    • FAT PERSON LIKELY TO MARRY FAT
    • PERSON , POSSIBLY AMPLIFYING
    • INCREASES IN OBESITY
  • 33. EXPOSURE TO CHEMICALS,
    • ENVIRONMENTAL
    • POLLUTANTS AND
    • SOME OF THESE
    • CAN LEAD TO
    • WEIGHT GAIN
  • 34. SOME GROUPS OF PEOPLE ARE FATTER THAN OTHERS
    • OVER THE LAST 40 YEARS OUR SOCIETY
    • HAS CHANGED IN MANY WAYS THAT
    • MAKE IT MORE AND MORE DIFFICULT
    • TO CONTROL THE W FACTOR
  • 35.  
  • 36. WT.AND CVD
  • 37.  
  • 38.  
  • 39. EFFECT OF WT.REDUCTION
  • 40.  
  • 41. X = METABOLIC XYNDROME OR SYNDROME X
  • 42. X= SYNDROME X
  • 43.  
  • 44. CRITERIA WHO/NCEP
  • 45. MANY DEFINITIONS BUT ALL CONTAIN 3 COMPONENTS ALL DEFINITIONS HAVE 3 COMPONENTS * OVERWT/WAIST * CARDIOVASCULAR RISK * ABNORMAL GLUCOSE METABOLISM
  • 46.  
  • 47. Some Types of Fat Are Worse Than Others
    • Fat can be distributed all over the body or primarily in the abdomen- visceral fat
    • Visceral fat is associated with the metabolic syndrome: high blood lipids, high blood pressure, & insulin resistance.
  • 48.  
  • 49.  
  • 50.  
  • 51.  
  • 52.  
  • 53.  
  • 54.  
  • 55.  
  • 56.  
  • 57.  
  • 58.  
  • 59. THE TREATABLE COMPONENTS ARE BLOODPRESSURE, BLOOD GLUCOSE, BLOOD FATS AND PROTHROMBOSIS
  • 60.  
  • 61. THE MAJOR FEATURE OF METABOLIC SYN.
    • PROGRESSIVE NATURE OF OVER WT. AND ASSOCIATED PROBLEMS
    • EPIDEMIOLOGICAL STUDIES SHOW A CONTINUUM OF CARDIOVASCULAR RISK .
    • THERE IS A PROGRESSIVE RISK WITH INCREASING BP , BLOOD SUGAR AND BLOOD FATS
  • 62.  
  • 63. PATHOPHYSIOLOGY METABOLIC SYNDROME
    • CNS SEEMS TO PLAY A ROLE IN THE RELEASE OF FAT FROM VISCERAL FAT DEPOT VIA SYMP. NS. LIVER & Ms BECOME INSULIN RESISTANT
  • 64.  
  • 65. CHD PREVALENCE
  • 66.  
  • 67.  
  • 68.
    • MAJOR FOCUSSHOULD BE ON BEHAVIOURAL THERAPY
    • WT.LOSS REDUCES THE INCIDENC OF
    • CVD
    • BEHAVTHAN METFORMIN .
  • 69.  
  • 70. THE FULL TYPE 2 TABLETS
    • IT IS NOT CURRENT
    • PRACTICE TO
    • PRESCRIBE FULL
    • TYPE 2 TAB
    • (METFORMIN , ACEI ,
    • STATIN , & ASPIRIN )
    • FOR PEOPLE WITH
    • METSY.
  • 71.  
  • 72.  
  • 73.  
  • 74.  
  • 75. Y = WHY THE PARTICULAR PERSON AT HIGH RISK
    • THE ‘ F ” WORDS ACCOUNT FOR MOST CASES OF METSY. & ITS COMPONENTS
    • *** FORTY : AGE OVER 40 YEARS
    • **** FAMILY H/o TYPE 2 DM IN A 1o RELATIVE ( RISK INCREASING TWO FOLD WITH ONE 1o RELATIVE AND THREE FOLD WITH TWO OR MORE )
    • **** FAT – OVER WEIGHT / WAIST
  • 76. NURSES HEALTH STUDY
    • AS FOR MANY OTHER CHRONIC DISEASES , AGE EMERGED AS A MAJOR RISK FACTOR.
    • DIABETES RISK INCREASES 10 FOLD BETWEEN THE AGES OF 20 – 60 YEARS.
    • LIFE TIME RISK , IF NO F H/o DIABETES IS 10%.
  • 77. THOSE WITH DIABETES ARE RESPONSIBLE FOR THEIR OWN DIABETES
    • THEY ARE THE LAZY GLUTTONS WHO ARE SUFFERING FROM THEIR SELF INDULGENCE .
    • IT IS TRUE THAT AGE AND GENES ARE FIXED AND THE FATNESS TO SOME DEGREE UNDER THE INDIVIDUALs CONTROL
  • 78. Z = SLEEP APNOEA
    • SLEEP APNOEA & LACK OF ZZZ….s
    • IS OFTEN ASSOCIATED WITH OTHER
    • CARDIO DIAB FACTORS .
    • OSA CAN PREDISPOSE TO INCREASING
    • WEIGHT AND WAIST AND TO THE
    • WORSENING OF THE METABOLIC
    • ABNORMALITIES ASSOC. WITH
    • SYNDROME X
  • 79.  
  • 80. OSA
    • OSA CAUSES SLEEP DISTURBANCE
    • RESULTS IN ACTIVTION OF HPA AXIS AND THE SYMPATHETIC RESPONSE .
    • DISTURBED SLEEP CAN LEAD TO DAY TIME SLEEPINESS .
    • THE COMBINTION OF NOCTURNAL HORMONE DISTURBANCE AND DAYTIME LETHARGY AGGRAVATES ADVERSE RISK FACTOR PROFILE
  • 81. LACK OF ZZZ…….
    • WORSENS THE METABOLIC PROFILE
    • AGGRAVATES DAYTIME SLEEPINESS
    • REDUCES THE MOTIVATION
    • REDUCES THE CAPACITY FOR LIFE STYLE CHANGES
    • NECK CIRCUMFERENCE (> 42 CM . ) OR A HIGH EPWORTH SLEEPINESS SCORE IDENTIFY THE PERSON AT RISK
  • 82. EPWORTH SLEEPINESS SCALE
    • HOW LIKELY ARE YOU TO DOZE OFF / FALL ASLEEP IN CERTAIN SITUATIONS
    • MEASURE DAY TIME SLEEPINESS.
    • DISTINGUISH NORMAL SUBJECTS FROM PATIENTS WITH VARIOUS CONDITIONS LIKE * OSA , * NARCOLEPSY ,
    • * IDIOPTHIC HYPERSOMNIA
  • 83.  
  • 84. ESS SCORE ILLUSTRATED
    • 0 - 10 NORMAL RANGE
    • 10 - 12 BORDERLINE
    • 12 - 24 ABNORMAL
  • 85. OSA AND CPAP
    • CPAP CAN DO WONDERS IN PEOPLE HAVING OSA.
    • RESULTS DRAMATIC –
    • WEIGHT AND WAIST LOSS
    • REDUCES BP & BLOOD SUGAR
    • LOSS OF BLOOD FATS
    • INCREASES IN WELL BEING
  • 86. CONCLUSIONS
    • EARLY RECOGNITION OF THE RISK FACTORS ENABLES CONTROL OF THE PROGRESSION OF THESE FACTORS BY LIFE STYLE CHANGES , MEDICATIONS OR BOTH .
    • THE MNEMONIC WXYZ PROVIDES A USEFUL APPROACH WHEN CONSIDERING THESE CARDIODIAB RISKS.
  • 87.