Sindrome Metabolica


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  • Sindrome Metabolica

    1. 1. Sindrome metabolica
    2. 2. Hypertension The other metabolic sy C-II terol. This red C-III HDL cholesterol B-100 and HDL compo TG Small dense LDL FFA Insulin IL-6 SNS ence of hyp VLDL cholesterol c Glucose duced choles core in comb TNF-α − protein–med IL-6 Insulin ing the parti − CRP poprotein co Glycogen − clearance of − tionships of sistance are FFA CO2 − with the cha FFA metabolism. In additio − composition Fibrinogen Adiponectin mM (~180 m PAI-1 dominance o Prothrombotic Triglyceride are thought state (intramuscular droplet) toxic to the e FIGURE 236-2 Pathophysiology of the metabolic syndrome. Free fatty acids (FFAs) through the adhere to gl
    3. 3. 1510 TABLE 236-1 NCEP:ATPIII 2001 AND IDF CRITERIA FOR THE METABOLIC SYNDROME Aging The metabol of the U.S. populati NCEP:ATPIII 2001 IDF Criteria for Central Adipositya greater percentage of Three or more of the following: Waist Circumference have the syndrome th dency of the syndrom PART 9 Central obesity: Waist circumference >102 cm (M), >88 cm (F) Men Women Ethnicity most populations aro Hypertriglyceridemia: Triglycerides ≥150 mg/dL ≥94 cm ≥80 cm Europid, Sub-Saharan or specific medication African, Eastern & Diabetes Mellitus D Low HDL cholesterol: <40 mg/dL and <50 mg/ Middle Eastern the NCEP and Intern dL, respectively, or specific medication ≥90 cm ≥80 cm South Asian, Chinese, tion (IDF) definition Hypertension: Blood pressure ≥130 mm systolic and ethnic South & or ≥85 mm diastolic or specific medication drome. It is estimate Central American Disorders of the Cardiovascular System Fasting plasma glucose ≥100 mg/dL or specific ≥85 cm ≥90 cm Japanese (~75%) of patients medication or previously diagnosed type 2 impaired glucose to diabetes Two or more of the following: metabolic syndrome. Fasting triglycerides >150 mg/dL or specific abolic syndrome in medication to a higher prevalen HDL cholesterol <40 mg/dL and <50 mg/dL for men and women, respectively, or specific patients with type 2 medication the syndrome. Blood pressure >130 systolic or >85 mm diastolic or previous diagnosis or specific medication Coronary Heart Disease Fasting plasma glucose ≥100 mg/dL or previously alence of the metabo diagnosed type 2 diabetes with coronary heart aInthis analysis, the following thresholds for waist circumference were used: White men, ≥94 cm; African-American with a prevalence of men, ≥94 cm; Mexican-American men, ≥90 cm; white women, ≥80 cm; African-American women, ≥80 cm; Mexican- mature coronary arte American women, ≥80 cm. For participants whose designation was “other race—including multiracial,” thresholds ticularly in women. that were once based on Europid cut points (≥94 cm for men and ≥80 cm for women) and once based on South rehabilitation and cha Asian cut points (≥90 cm for men and ≥80 cm for women) were used. For participants who were considered “other Hispanic,” the IDF thresholds for ethnic South and Central Americans were used. trition, physical activi Abbreviations: NCEP:ATPIII, National Cholesterol Education Program, Adult Treatment Panel III; IDF, International Di- in some cases, pha abetes Foundation HDL, high-density lipoprotein. prevalence of the synd
    4. 4. fattori di rischio • obesità • sedentarietà • età • diabete: ~75% pz con DM II ha sindrome metabolica • malattia coronarica • dislipidemie
    5. 5. • resistenza insulina per aumento acidi grassi circolanti • insulina normalmente inibisce lipolisi e favolisce LPL • aumenta produzione epatica di glucosio e VLDLs • in condizioni fisiologiche insulina è valodilatatore
    6. 6. ortant criteria Hypertension The relationship between insulin resistance and hyper- ference tension is well established. Paradoxically, under normal physiologic ases in conditions, insulin is a vasodilator with secondary effects on sodium quires reabsorption in the kidney. However, in the setting of insulin resis- tissue- tance, the vasodilatory effect of insulin is lost, but the renal effect on ases in sodium reabsorption is preserved. Sodium reabsorption is increased ystem- in Caucasians with the metabolic syndrome but not in Africans or olism. Asians. Insulin also increases the activity of the sympathetic nervous e with system, an effect that may also be preserved in the setting of the insulin ay ex- resistance. Finally, insulin resistance is characterized by pathway-spe- lations cific impairment in phosphatidylinositol 3-kinase signaling. In the en- at pre- dothelium, this may cause an imbalance between the production of ut not nitric oxide and secretion of endothelin-1, leading to decreased blood flow. Although these mechanisms are provocative, when insulin action is assessed by levels of fasting insulin or by the Homeostasis Model As- liver is sessment (HOMA), insulin resistance contributes only modestly to the glycer- increased prevalence of hypertension in the metabolic syndrome. nsulin