The Wxyz Of Cardiodiab Risk

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

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  • The Wxyz Of Cardiodiab Risk

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

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