Metabolic Syndrome, Diabetes, and Cardiovascular Disease: Implications for Preventive Cardiology   <ul><li>Nathan D. Wong,...
Overview of Diabetes in the United States
Diabetes Prevalence, 1990-1998
Age-adjusted prevalence of physician-diagnosed diabetes in Adults age 18 and older by race/ethnicity and sex  (NHANES: 199...
 
 
Risk of Cardiovascular Events in  Diabetics   Framingham Study <ul><li>  Age-adjusted </li></ul><ul><li>  Biennial Rate  A...
Insulin Resistance
Natural History of Type 2 Diabetes
Development of Type 2 Diabetes
Hyperglycemia in Type 2 Diabetes Results From Three Major Metabolic Defects
Relationship Between Obesity and Insulin Resistance and Dyslipidemia
Insulin Resistance: Associated Conditions
New Cases of ESRD in the United States
New Cases of ESRD in the United States  by Cause and Ethnicity, 1998
Microalbuminuria
Cardiovascular Disease and Diabetes
Probability of Death From CHD in Patients With Type 2 Diabetes With or Without Previous MI
Framingham Heart Study 30-Year Follow-Up: CVD Events in Patients With Diabetes (Ages 35-64) 10 9 20 11 9 6 38 19 3* 30 0 2...
Presentation <ul><li>Name: WJC  </li></ul><ul><li>Age: 54 years old  </li></ul><ul><li>Professional: former chief executiv...
Presentation (cont’d) <ul><li>Examination: </li></ul><ul><ul><li>Height: 6 ft 2 in </li></ul></ul><ul><ul><li>Weight: 220 ...
Presentation (cont’d) <ul><li>Medications:  </li></ul><ul><ul><li>sildenafil 50 mg prn </li></ul></ul><ul><ul><li>amlodipi...
The Metabolic Syndrome Insulin Resistance Hypertension Type 2 Diabetes Disordered Fibrinolysis Complex Dyslipidemia TG, LD...
Revised ATP III Metabolic Syndrome Oct 2005 *Diagnosis is established when   3 of these risk factors are present. † Abdom...
International Diabetes Federation Definition:  Abdominal obesity  plus  two other components:  elevated BP, low HDL, eleva...
 
 
 
 
 
 
Prevalence of the Metabolic Syndrome Among US Adults NHANES 1988-1994 Age (years) Ford E et al.  JAMA . 2002(287):356. 199...
Prevalence of the NCEP Metabolic Syndrome:  NHANES III by Sex and Race/Ethnicity Prevalence, % Men Ford ES et al.  JAMA  2...
Cardiovascular Disease (CVD) and Total Mortality:  US Men and Women Ages 30-74 (age, gender, and risk-factor adjusted Cox ...
 
Metabolic Syndrome, CVD Events, and Mortality <ul><li>European cohort studies (6156 men and 5356 women):  Modified WHO def...
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Metabolic Syndrome, Diabetes, and Cardiovascular Disease ... Metabolic Syndrome, Diabetes, and Cardiovascular Disease .

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Metabolic Syndrome, Diabetes, and Cardiovascular Disease ... Metabolic Syndrome, Diabetes, and Cardiovascular Disease .

  1. 1. Metabolic Syndrome, Diabetes, and Cardiovascular Disease: Implications for Preventive Cardiology <ul><li>Nathan D. Wong, PhD, FACC, FAHA </li></ul><ul><li>Professor and Director </li></ul><ul><li>Heart Disease Prevention Program </li></ul><ul><li>Division of Cardiology </li></ul><ul><li>University of California, Irvine </li></ul>
  2. 2. Overview of Diabetes in the United States
  3. 3. Diabetes Prevalence, 1990-1998
  4. 4. 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.
  5. 7. Risk of Cardiovascular Events in Diabetics Framingham Study <ul><li> Age-adjusted </li></ul><ul><li> Biennial Rate Age-adjusted </li></ul><ul><li> Per 1000 Risk Ratio </li></ul><ul><li>Cardiovascular Event Men Women Men Women </li></ul><ul><li>Coronary Disease 39 21 1.5** 2.2*** </li></ul><ul><li>Stroke 15 6 2.9*** 2.6*** </li></ul><ul><li>Peripheral Artery Dis. 18 18 3.4*** 6.4*** </li></ul><ul><li>Cardiac Failure 23 21 4.4*** 7.8*** </li></ul><ul><li>All CVD Events 76 65 2.2*** 3.7*** </li></ul><ul><li>Subjects 35-64 36-year Follow-up **P<.001,***P<.0001 </li></ul>_________________________________________________________________ _________________________________________________________________
  6. 8. Insulin Resistance
  7. 9. Natural History of Type 2 Diabetes
  8. 10. Development of Type 2 Diabetes
  9. 11. Hyperglycemia in Type 2 Diabetes Results From Three Major Metabolic Defects
  10. 12. Relationship Between Obesity and Insulin Resistance and Dyslipidemia
  11. 13. Insulin Resistance: Associated Conditions
  12. 14. New Cases of ESRD in the United States
  13. 15. New Cases of ESRD in the United States by Cause and Ethnicity, 1998
  14. 16. Microalbuminuria
  15. 17. Cardiovascular Disease and Diabetes
  16. 18. Probability of Death From CHD in Patients With Type 2 Diabetes With or Without Previous MI
  17. 19. Framingham Heart Study 30-Year Follow-Up: CVD Events in Patients With Diabetes (Ages 35-64) 10 9 20 11 9 6 38 19 3* 30 0 2 4 6 8 10 Age-adjusted annual rate/1,000 Men Women Total CVD CHD Cardiac failure Intermittent claudication Stroke Risk ratio P <0.001 for all values except * P <0.05. Wilson PWF, Kannel WB. In: Hyperglycemia, Diabetes and Vascular Disease. Ruderman N et al, eds. Oxford; 1992.
  18. 20. Presentation <ul><li>Name: WJC </li></ul><ul><li>Age: 54 years old </li></ul><ul><li>Professional: former chief executive </li></ul><ul><li>Personal: wife lives principally in Washington, DC; he has a personal cook in his suburban NY home </li></ul><ul><li>Lifestyle: </li></ul><ul><ul><li>Occasional use of cigars </li></ul></ul><ul><ul><li>has had a long-term weight problem </li></ul></ul><ul><ul><li>likes to play golf </li></ul></ul>
  19. 21. Presentation (cont’d) <ul><li>Examination: </li></ul><ul><ul><li>Height: 6 ft 2 in </li></ul></ul><ul><ul><li>Weight: 220 lb (BMI 28 kg/m 2 ) </li></ul></ul><ul><ul><li>Waist circumference: 41 in </li></ul></ul><ul><ul><li>BP: 150/88 mm Hg </li></ul></ul><ul><ul><li>P: 64 bpm </li></ul></ul><ul><ul><li>RR: 12 breaths/min </li></ul></ul><ul><li>Cardiopulmonary exam: normal </li></ul>
  20. 22. Presentation (cont’d) <ul><li>Medications: </li></ul><ul><ul><li>sildenafil 50 mg prn </li></ul></ul><ul><ul><li>amlodipine 5 mg/d </li></ul></ul><ul><li>Laboratory results: </li></ul><ul><ul><li>TC: 220 mg/dL </li></ul></ul><ul><ul><li>HDL-C: 36 mg/dL </li></ul></ul><ul><ul><li>LDL-C: 140 mg/dL </li></ul></ul><ul><ul><li>TG: 220 mg/dL </li></ul></ul><ul><ul><li>FBS: 120 mg/dL </li></ul></ul>
  21. 23. The Metabolic Syndrome Insulin Resistance Hypertension Type 2 Diabetes Disordered Fibrinolysis Complex Dyslipidemia TG, LDL HDL Endothelial Dysfunction Systemic Inflammation Athero- sclerosis Visceral Obesity Adapted from the ADA. Diabetes Care. 1998;21:310-314; Pradhan AD et al. JAMA. 2001;286:327-334.
  22. 24. 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. <40 mg/dL <50 mg/dL or Rx for ↓ HDL Men Women > 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 Level Risk Factor
  23. 25. International Diabetes Federation Definition: Abdominal obesity plus two other components: elevated BP, low HDL, elevated TG, or impaired fasting glucose
  24. 32. Prevalence of the Metabolic Syndrome Among US Adults NHANES 1988-1994 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 Prevalence (%) 0 5 10 15 20 25 30 35 40 45 20-29 30-39 40-49 50-59 60-69 > 70 Men Women
  25. 33. 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 25% 16% 28% 21% 23% 26% 36% 20% White African American Mexican American Other
  26. 34. 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<.05, ** p<.01, **** p<.0001 compared to none * *** *** *** ** *** *** *** *** *** ***
  27. 36. Metabolic Syndrome, CVD Events, and Mortality <ul><li>European cohort studies (6156 men and 5356 women): Modified WHO definition of MetS associated with all-cause mortality (RR=1.44 [1.17-1.84] in men and 1.38 [1.02-1.87] in women) and CVD mortality (RR=2.26 [1.61-3.17] in men and 2.78 [1.57-4.94 in women) (Hu et al. Arch Intern Med 2004; 164: 1066-76) </li></ul><ul><li>Atherosclerosis Risk in Communities (ARIC) study (12,089 men and women): 11 year follow-up, ATP III MetS associated with 1.5-2-fold greater likelihood of developing CHD and stroke, but MetS did not improve prediction over FRS (McNeill et al. Diab Care 2005; 28: 385-90) </li></ul><ul><li>Cardiovascular Health Study (CHS) (2,175 elderly subjects): ATP III definition associated with 38% increased risk (p<0.01) of coronary/cerebrovascular events (Scuteri et al., Diab Care 2005; 28: 882-7) </li></ul>

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