Cardiometabolic Syndrome (2)

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Cardiometabolic Syndrome (2)

  1. 1. <ul><li>Cardiometabolic Syndrome </li></ul><ul><li>Nabil Sulaiman </li></ul><ul><li>HOD Family and Community Medicine, Sharjah University and University of Melbourne </li></ul><ul><li>& </li></ul><ul><li>Dr Dhafir A. Mahmood </li></ul><ul><li>Consultant Endocrinologist </li></ul><ul><li>Al- Qassimi & Al-Kuwait Hospital </li></ul><ul><li>Sharjah </li></ul>
  2. 2. Cardiometabolic Syndrome II Aims <ul><li>Abdominal obesity prevalence </li></ul><ul><li>Targeting Cardiometabolic Risk factors </li></ul><ul><li>Multiple Risk Factor management </li></ul><ul><li>A Critical Look at the Metabolic Syndrome </li></ul>
  3. 3. Clustering of Components: <ul><li>Hypertension: BP. > 140/90 </li></ul><ul><li>Dyslipidemia: TG > 150 mg/ dL ( 1.7 mmol/L ) </li></ul><ul><li>HDL- C < 35 mg/ dL (0.9 mmol/L) </li></ul><ul><li>Obesity (central): BMI > 30 kg/M2 </li></ul><ul><li>Waist girth > 94 cm (37 inch) </li></ul><ul><li>Waist/Hip ratio > 0.9 </li></ul><ul><li>Impaired Glucose Handling: IR , IGT or DM </li></ul><ul><li>FPG > 110 mg/dL (6.1mmol/L) </li></ul><ul><li>2hr.PG >200 mg/dL(11.1mmol/L) </li></ul><ul><li>Microalbuninuria (WHO) </li></ul>
  4. 4. Global cardiometabolic risk* Gelfand EV et al , 2006; Vasudevan AR et al , 2005 * working definition
  5. 5. <ul><li>The new IDF definition focusses on abdominal obesity rather than insulin resistance </li></ul>International Diabetes Federation (IDF) Consensus Definition 2005
  6. 6. Why a New Definition of the MeS: IDF Objectives <ul><li>Needs: </li></ul><ul><li>To identify individuals at high risk of developing cardiovascular disease (and diabetes) </li></ul><ul><li>To be useful for clinicians </li></ul><ul><li>To be useful for international comparisons </li></ul>
  7. 7. Central Obesity <ul><li>IDF: </li></ul><ul><ul><li>Central obesity - waist circumference >94 cm for Europid men, >80 Europid women with ethnicity specific values for other groups </li></ul></ul><ul><li>WHO: </li></ul><ul><ul><li>Waist-hip ratio >0.9 - men or >0.85 - women </li></ul></ul><ul><li>ATP III: </li></ul><ul><ul><li>Waist circumference >40 in. - men, </li></ul></ul><ul><ul><li>> 35 in. - women </li></ul></ul>
  8. 8. Fat Topography In Type 2 Diabetic Subjects Intramuscular Intrahepatic Subcutaneous Intra- abdominal FFA * TNF-alpha * Leptin * IL-6 (CRP) * Tissue Factor * PAI-1 * Angiotensinogen *
  9. 9. Abdominal obesity and increased risk of cardiovascular events Dagenais GR et al , 2005 Adjusted relative risk 1 1 1 1.17 1.16 1.14 1.29 1.27 1.35 0.8 1 1.2 1.4 CVD death MI All-cause deaths Tertile 1 Tertile 2 Tertile 3 Men Women <95 95–103 >103 <87 87–98 >98 Waist circumference (cm): The HOPE study Adjusted for BMI, age, smoking, sex, CVD disease, DM, HDL-cholesterol, total-C; CVD: cardiovascular disease; MI: myocardial infarction; BMI: body mass index; DM: diabetes mellitus; HDL: high-density lipoprotein cholesterol
  10. 10. Abdominal obesity increases the risk of developing type 2 diabetes <71 71–75.9 76–81 81.1–86 86.1–91 91.1–96.3 >96.3 24 20 16 12 8 4 0 Relative risk Waist circumference (cm) Carey VJ et al , 1997
  11. 11. Abdominal obesity is linked to an increased risk of coronary heart disease Waist circumference has been shown to be independently associated with increased age-adjusted risk of CHD, even after adjusting for BMI and other cardiovascular risk factors Rexrode KM et al , 1998 CHD: coronary heart disease; BMI: body mass index 0.0 0.5 1.0 1.5 2.0 2.5 3.0 <69.8 69.8  <74.2 74.2  <79.2 79.2  <86.3 86.3  <139.7 1.27 2.06 2.31 2.44 p for trend = 0.007 Relative risk Quintiles of waist circumference (cm)
  12. 12. Diabetes in the new millennium Interdisciplinary problem <ul><li>Diabetes </li></ul>
  13. 13. Diabetes in the new millennium Interdisciplinary problem <ul><li>OBESITY </li></ul>
  14. 14. Diabetes in the new millennium Interdisciplinary problem <ul><li>DIAB </li></ul><ul><li>ESITY </li></ul>
  15. 15. <ul><li>Targeting </li></ul><ul><li>Cardiometabolic Risk </li></ul>
  16. 16. Central obesity: a driving force for cardiovascular disease & diabetes “ Balzac” by Rodin Front Back
  17. 17. Intra-abdominal adiposity is closely correlated with abdominal obesity <ul><ul><li>To assess IAA, the simplest measure of abdominal obesity is waist circumference, which is strongly correlated with direct measurement of IAA by CT scan or MRI, considered to be the gold standard </li></ul></ul>Després JP et al , 2001; Pouliot MC et al , 2004 300 200 100 0 r = 0.80 60 80 100 120 IAA Waist circumference (cm) IAA (cm 2 ) IAA: intra-abdominal adiposity; CT: computed tomography; MRI: magnetic resonance imaging
  18. 18. Intra-abdominal adiposity is a major contributor to increased cardiometabolic risk Kershaw EE et al , 2004; Lee YH et al , 2005; Boden G et al , 2002 Inflammation Insulin resistance Dyslipidaemia Increased cardiometabolic risk IAA = high risk fat IAA: intra-abdominal adiposity Associated with inflammatory markers (C-reactive protein)  Free fatty acids  Secretion of adipokines ( ↓ adiponectin) 
  19. 19. <ul><li>Waist Circumference </li></ul>
  20. 20. Intra-abdominal adiposity and dyslipidaemia Pouliot MC et al , 1992 310 248 186 124 62 0 60 45 30 mg/dL mg/dL Triglycerides Lean HDL-cholesterol Visceral fat (obese subjects) Low High Lean Visceral fat (obese subjects) Low High HDL: high-density lipoprotein
  21. 21. Insulin Resistance: Associated Conditions
  22. 22. Targeting Cardiometaboilc Risk Defining cardiometabolic Risk <ul><li>Cardiovascular Disease </li></ul><ul><li>Abdominal Obesity Glucose intolerance </li></ul><ul><li>Insulin Resistance </li></ul><ul><li>Dyslipedemia Hypertension </li></ul>
  23. 23. Targeting Cardiometaboilc Risk Defining cardiometabolic Risk <ul><li>Major Unmet Clinical Need </li></ul><ul><li>Classical Risk Factors </li></ul><ul><li>Novel Risk Factors </li></ul><ul><li>Cluster Risk Factors </li></ul><ul><li>LDL-C BP Smoking DM-2 Insulin HDL-C TNF & IL-6 </li></ul><ul><li>Abdominal Obesity </li></ul><ul><li>Glucose PAI-1 TG </li></ul><ul><li>Cardiovascular Disease </li></ul>
  24. 24. Linked Metabolic Abnormalities: <ul><li>Impaired glucose handling/ insulin resistance </li></ul><ul><li>Atherogenic dyslipidemia </li></ul><ul><li>Endothelial dysfunction </li></ul><ul><li>Prothrombotic state </li></ul><ul><li>Hemodynamic changes </li></ul><ul><li>Proinflammatory state </li></ul><ul><li>Excess ovarian testosterone production </li></ul><ul><li>Sleep-disordered breathing </li></ul>
  25. 25. Resulting Clinical Conditions: <ul><li>Type 2 diabetes </li></ul><ul><li>Essential hypertension </li></ul><ul><li>Polycystic ovary syndrome (PCOS) </li></ul><ul><li>Nonalcoholic fatty liver disease </li></ul><ul><li>Sleep apnea </li></ul><ul><li>Cardiovascular Disease (MI, PVD, Stroke) </li></ul><ul><li>Cancer (Breast, Prostate, Colorectal, Liver) </li></ul>
  26. 26. Targeting Cardiometaboilc Risk <ul><li>Site of Action Mechanisms Addresses </li></ul><ul><li>Adipose tissues Adiponectin Dyslipidemia </li></ul><ul><li>Lipogeenesis Insulin resistance </li></ul><ul><li>Muscle G uptake Insulin resistance </li></ul><ul><li>Liver Lipogeenesis Dyslipidemia </li></ul><ul><li>Insulin resistance </li></ul><ul><li>GI tract Satiety signals Body weight </li></ul><ul><li>Waist circumference </li></ul><ul><li>Hypothalamus Food intake Body weight </li></ul><ul><li>Waist circumference </li></ul><ul><li>Genetic? </li></ul>
  27. 27. Multiple Risk Factor Management <ul><li>Obesity </li></ul><ul><li>Glucose Intolerance </li></ul><ul><li>Insulin Resistance </li></ul><ul><li>Lipid Disorders </li></ul><ul><li>Hypertension </li></ul><ul><li>Goals: Minimize Risk of Type 2 Diabetes and Cardiovascular Disease </li></ul>
  28. 28. Glucose Abnormalities: <ul><li>IDF: </li></ul><ul><ul><li>FPG >100 mg/dL (5.6 mmol. L) or previously diagnosed type 2 diabetes </li></ul></ul><ul><ul><li>(ADA: FBS >100 mg/dL [ 5.6 mmol/L ]) </li></ul></ul>
  29. 29. Hypertension: <ul><li>IDF: </li></ul><ul><ul><li>BP >130/85 or on Rx for previously diagnosed hypertension </li></ul></ul>
  30. 30. Dyslipidemia: <ul><li>IDF: </li></ul><ul><ul><li>Triglycerides - >150mg/dL (1.7 mmol /L) </li></ul></ul><ul><ul><li>HDL - <40 mg/dL (men), <50 mg/dL (women) </li></ul></ul>
  31. 31. Insulin Resistance: <ul><li>Hyperinsulinemic individuals are at risk for developing Diabetes, Dyslipidemia, Hypertension & ultimately Cardiovascular disease </li></ul><ul><li>Patients with Metabolic Syndrome are 3.5 times as likely to die from Cardiovascular disease compared to normal people </li></ul>
  32. 32. Public Health Approach
  33. 33. Screening/Public Health Approach <ul><li>Public Education </li></ul><ul><li>Screening for at risk individuals: </li></ul><ul><ul><li>Blood Sugar/ HbA1c </li></ul></ul><ul><ul><li>Lipids </li></ul></ul><ul><ul><li>Blood pressure </li></ul></ul><ul><ul><li>Tobacco use </li></ul></ul><ul><ul><li>Body habitus </li></ul></ul><ul><ul><li>Family history </li></ul></ul>
  34. 34. Life-Style Modification: Is it Important? <ul><li>Exercise </li></ul><ul><ul><li>Improves CV fitness, weight control, sensitivity to insulin, reduces incidence of diabetes </li></ul></ul><ul><li>Weight loss </li></ul><ul><ul><li>Improves lipids, insulin sensitivity, BP levels, reduces incidence of diabetes </li></ul></ul><ul><li>Goals: </li></ul><ul><li>Brisk walking - 30 min./day </li></ul><ul><li>10% reduction in body wt. </li></ul>
  35. 35. Smoking Cessation / Avoidance: <ul><li>A risk factor for development in children and adults </li></ul><ul><li>Both passive and active exposure harmful </li></ul><ul><li>A major risk factor for: </li></ul><ul><ul><li>insulin resistance and metabolic syndrome </li></ul></ul><ul><ul><li>macrovascular disease (PVD, MI, Stroke) </li></ul></ul><ul><ul><li>microvascular complications of diabetes </li></ul></ul><ul><ul><li>pulmonary disease, etc. </li></ul></ul>
  36. 36. Diabetes Control - How Important? <ul><li>Goals : </li></ul><ul><li>FBS - premeal <110, </li></ul><ul><li>postmeal <180. </li></ul><ul><li>HbA1c <7% </li></ul><ul><li>For every 1% rise in Hb A1c there is an 18% rise in risk of cardiovascular events & a 28% increase in peripheral arterial disease </li></ul><ul><li>Evidence is accumulating to show that tight blood sugar control in both Type 1 and Type 2 diabetes reduces risk of CVD </li></ul>
  37. 37. Lifestyle modification <ul><li>Diet </li></ul><ul><li>Exercise </li></ul><ul><li>Weight loss </li></ul><ul><li>Smoking cessation </li></ul><ul><li>If a 1% reduction in HbA 1c is achieved, you could expect a reduction in risk of: </li></ul><ul><ul><li>21% for any diabetes-related endpoint </li></ul></ul><ul><ul><li>37% for microvascular complications </li></ul></ul><ul><ul><li>14% for myocardial infarction </li></ul></ul>However, compliance is poor and most patients will require oral pharmacotherapy within a few years of diagnosis Stratton IM et al . BMJ 2000; 321: 405–412.
  38. 38. Overcome Insulin Resistance/ Diabetes: <ul><li>Insulin Sensitizers: </li></ul><ul><ul><li>Biguanides – metformin </li></ul></ul><ul><ul><li>Glitazones, Gltazars </li></ul></ul><ul><ul><li>Can be used in combination </li></ul></ul><ul><li>Insulin Secretagogues: </li></ul><ul><ul><li>Sulfonylurea - glipizide, glyburide, glimeparide, glibenclamide </li></ul></ul><ul><ul><li>Meglitinides - repaglanide, netiglamide </li></ul></ul>
  39. 39. Insulin <ul><li>Insulin Analogues: </li></ul><ul><ul><li>Lyspro /Aspart /glulysine used with meals </li></ul></ul><ul><ul><li>Glargine & Livemer as basal insulin </li></ul></ul><ul><li>Continuous Subcutaneous Insulin Infusion (CSII) </li></ul><ul><li>NPH/Regular, NPH/logs - Mixed or in fixed combinations (70/30, 75/25, 50/50) </li></ul><ul><li>Insulin combined with oral agents </li></ul>
  40. 40. BP Control - How Important? <ul><li>Goal: BP. <130/80 </li></ul><ul><li>MRFIT and Framingham Heart Studies: </li></ul><ul><ul><li>Conclusively proved the increased risk of CVD with long-term sustained hypertension </li></ul></ul><ul><ul><li>Demonstrated a 10 year risk of cardiovascular disease in treated patients vs non-treated patients to be 0.40. </li></ul></ul><ul><ul><li>40% reduction in stroke with control of HTN </li></ul></ul><ul><li>Precedes literature on Metabolic Syndrome </li></ul>
  41. 41. Lipid Control - How Important? <ul><li>Goals: HDL >40 mg% (>1.1 mmol /l) </li></ul><ul><li> LDL <100 mg/dL (<3.0 mmol /l) </li></ul><ul><li>TG <150 mg% (<1.7 mmol /l) </li></ul><ul><li>Multiple major studies show 24 - 37% reductions in cardiovascular disease risk with use of statins and fibrates in the control of hyperlipidemia. </li></ul>
  42. 42. Substantial residual cardiovascular risk in statin-treated patients Placebo Statin Year of follow-up % patients 0 1 2 3 4 5 6 10 20 30 0 Risk reduction=24% (p<0.0001) The MRC/BHF Heart Protection Study Heart Protection Study Collaborative Group, 2002 19.8% of statin-treated patients had a major cardiovascular event by 5 years
  43. 43. Medications: <ul><li>Hypertension: </li></ul><ul><ul><li>ACE inhibitors, ARBs </li></ul></ul><ul><ul><li>Others - thiazides, calcium channel blockers, beta blockers, alpha blockers </li></ul></ul><ul><ul><li>Central acting Alfa agonist : Moxolidin </li></ul></ul><ul><li>Dylipidemia: </li></ul><ul><ul><li>Statins, Fibrates, Niacin </li></ul></ul><ul><li>Platelet inhibitors: </li></ul><ul><ul><li>ASA, clopidogrel </li></ul></ul>
  44. 45. Antihypertensive Medications: <ul><li>Target BP : <130/80 </li></ul><ul><li>Angiotensin -converting Enzyme Inhibitors (ACEI) </li></ul><ul><li>Angiotensin II Receptor (ARB) Blockers </li></ul><ul><li>Combination with Thiazides, Calcium Channel Blockers, Cardioselective Beta Blockers </li></ul>
  45. 48. Individual metabolic abnormalities among Qatari population according to gender (Musallam et al 08) <ul><li> Men (n = 405) Women (n=412) </li></ul><ul><li>Variable n(%) n(%) p-Value </li></ul><ul><li>ATP III </li></ul><ul><li>Abdominal obesity 227(56.0) 308(74.8) <0.001 </li></ul><ul><li>Hypertension 143(35.3) 156(37.9) 0.448 </li></ul><ul><li>Diabetes 77(19.0) 107(26.0) 0.017 </li></ul><ul><li>Hypertriglyceridemia 113(27.9) 83(20.1) 0.009 </li></ul><ul><li>Low HDL 95(23.5) 121(29.4) 0.055 </li></ul>
  46. 49. Individual metabolic abnormalities among Qatari population according to gender <ul><li> Men (n = 405) Women (n=412) </li></ul><ul><li>Variable n(%) n(%) p-Value </li></ul><ul><li>None 88(21.7) 74(18.0) – </li></ul><ul><li>One 103(25.4) 100(24.3) 0.033 </li></ul><ul><li>Two 125(30.9) 111(26.9) – </li></ul><ul><li>Three or more 89(22.0) 127(30.8) – </li></ul>No of components of ATP III
  47. 50. Prevalence of MeS in different Countries * Crude rates Mussallam et al. Int J Food Safety and PH 2008 Prevalence (%) Sample Year Country 23 542 2003 Arab Americans 21 1419 2001 Oman 36 1121 2002 Jordan 20.8 2250 2004 Saudi Arabia 17* 1998 Palestine 27.6 817 2007 Qatar 33.4* 1637 2004 Turkey 33.7 10368 ? Iran
  48. 51. A Critical Look at the Metabolic Syndrome <ul><li>Is it a Syndrome?* </li></ul><ul><li>“… too much clinically important information is missing to warrant its designations as a syndrome.” </li></ul><ul><li>Unclear pathogenesis, Insulin resistance is not a consistent finding in some definitions. </li></ul><ul><li>CVD risks has not shown to be greater than the sum of it’s individual components. </li></ul><ul><li>* ADA </li></ul>
  49. 52. A Critical Look at the Metabolic Syndrome <ul><li>Research </li></ul><ul><li>“ Until much needed research is completed, clinicians should evaluate and treat all CVD risk factors without regard to whether a patient meets the criteria for diagnosis of the ‘metabolic syndrome’.” </li></ul>
  50. 53. A Critical Look at the Metabolic Syndrome <ul><li>Lifestyle </li></ul><ul><li>The advice remains to treat individual risk factors when present & to prescribe therapeutic lifestyle changes & weight management for obese patients with multiple risk factors. </li></ul>
  51. 54. Insulin Resistance: Associated Conditions
  52. 55. Thank You
  53. 57. Determinants and dynamics of the CVD Epidemic in the developing Countries <ul><li>Data from South Asian Immigrant studies </li></ul><ul><li>Excess, early, and extensive CHD in persons of South Asian origin </li></ul><ul><li>The excess mortality has not been fully explained by the major conventional risk factors. </li></ul><ul><li>Diabetes mellitus and impaired glucose tolerance highly prevalent. (Reddy KS, circ 1998). </li></ul><ul><li>Central obesity, ↑triglycerides, ↓HDL with or without glucose intolerance, characterize a phenotype. </li></ul><ul><li>genetic factors predispose to ↑lipoprotein(a) levels, the central obesity/glucose intolerance/dyslipidemia complex collectively labeled as the “metabolic syndrome” </li></ul>
  54. 58. Determinants and dynamics of the CVD epidemic in the developing countries <ul><li>Other Possible factors </li></ul><ul><li>Relationship between early life characteristics and susceptibility to NCD in adult hood ( Barker’s hypothesis) ( Baker DJP,BMJ,1993) </li></ul><ul><ul><li>Low birth weight associated with increased CVD </li></ul></ul><ul><ul><li>Poor infant growth and CVD relation </li></ul></ul><ul><li>Genetic–environment interactions </li></ul><ul><li>(Enas EA, Clin. Cardiol. 1995; 18: 131–5) </li></ul><ul><ul><li>Amplification of expression of risk to some environmental changes esp. South Asian population) </li></ul></ul><ul><ul><li>Thrifty gene (e.g. in South Asians) </li></ul></ul>
  55. 59. CVD epidemic in developing & developed countries. Are they same? <ul><li>Urban populations have higher levels of CVD risk factors related to diet and physical activity (overweight, hypertension, dyslipidaemia and diabetes) </li></ul><ul><li>Tobacco consumption is more widely prevalent in rural population </li></ul><ul><li>The social gradient will reverse as the epidemics mature. </li></ul><ul><li>The poor will become progressively vulnerable to the ravages of these diseases and will have little access to the expensive and technology-curative care. </li></ul><ul><li>The scarce societal resources to the treatment of these disorders dangerously depletes the resources available for the ‘unfinished agenda’ of infectious and nutritional disorders that almost exclusively afflict the poor </li></ul>
  56. 60. Burden of CVD in Pakistan <ul><li>Coronary heart disease </li></ul><ul><li>Mortality statistics </li></ul><ul><li>Specific mortality data ideal for making comparisons with other countries are not available </li></ul><ul><li>Inadequate and inappropriate death certification, and multiple concurrent causes of death </li></ul>
  57. 61. Central obesity: a driving force for cardiovascular disease & diabetes “ Balzac” by Rodin Front Back
  58. 62. Why people physically inactive? <ul><li>Lack of awareness regarding the of physical activity for health fitness and prevention of diseases </li></ul><ul><li>Social values and traditions regarding physical exercise (women, restriction). </li></ul><ul><li>Non-availability public places suitable for physical activity (walking and cycling path, gymnasium). </li></ul><ul><li>Modernization of life that reduce physical activity (sedentary life, TV, Computers, tel, cars). </li></ul>
  59. 63. Insulin Resistance: Associated Conditions
  60. 64. 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
  61. 66. Prevention of CVD <ul><li>There is an urgent need to establish appropriate research studies, increase awareness of the CVD burden, and develop preventive strategies. </li></ul><ul><li>Prevention and treatment strategies that have been proven to be effective in developed countries should be adapted for developing countries. </li></ul><ul><li>Prevention is the best option as an approach to reduce CVD burden. </li></ul><ul><li>Do we know enough to prevent this CVD Epidemic in the first place. </li></ul>
  62. 67. <ul><li>The new IDF definition focusses on abdominal obesity rather than insulin resistance </li></ul>International Diabetes Federation (IDF) Consensus Definition 2005
  63. 68. International Diabetes Federation (IDF) Consensus Definition 2005 Central Obesity Waist circumference – ethnicity specific* – for Europids: Male > 94 cm Female > 80 cm plus any two of the following: Raised triglycerides > 150 mg/dL (1.7 mmol/L) or specific treatment for this lipid abnormality Reduced HDL cholesterol < 40 mg/dL (1.03 mmol/L) in males < 50 mg/dL (1.29 mmol/L) in females or specific treatment for this lipid abnormality Raised blood pressure Systolic : > 130 mmHg or Diastolic: > 85 mmHg or Treatment of previously diagnosed hypertension Raised fasting plasma glucose Fasting plasma glucose > 100 mg/dL (5.6 mmol/L) or Previously diagnosed type 2 diabetes If above 5.6 mmol/L or 100 mg/dL, OGTT is strongly recommended but is not necessary to define presence of the syndrome.
  64. 69. Treatment of Metabolic Syndrome: 2005 Aspirin Diet, Exercise, Lifestyle change Stop smoking CB1 Receptor Blocker Oral hypoglycaemics Antihypertensives Statins & Fibrates Insulin ACEI &/or A2 receptor blockers
  65. 70. <ul><li>Primary management for the Metabolic Syndrome is healthy lifestyle promotion. This includes: </li></ul><ul><li>moderate calorie restriction (to achieve a 5-10% loss of body weight in the first year) </li></ul><ul><li>moderate increases in physical activity </li></ul><ul><li>change dietary composition to reduce saturated fat and total intake, increase fibre and, if appropriate, reduce salt intake. </li></ul>Recommendations for treatment
  66. 71. <ul><li>Appropriate & aggressive therapy is essential for reducing patient risk of cardiovascular disease </li></ul><ul><li>Lifestyle measures should be the first action </li></ul><ul><li>Pharmacotherapy should have beneficial effects on </li></ul><ul><ul><li>Glucose intolerance/diabetes </li></ul></ul><ul><ul><li>Obesity </li></ul></ul><ul><ul><li>Hypertension </li></ul></ul><ul><ul><li>Dyslipidaemia </li></ul></ul><ul><li>Ideally, treatment should address all of the components of the syndrome and not the individual components </li></ul>Management of the Metabolic Syndrome
  67. 72. Summary: new IDF definition for the Metabolic Syndrome <ul><li>The new IDF definition addresses both clinical and research needs: </li></ul><ul><li>provides a simple entry point for primary care physicians to diagnose the Metabolic Syndrome </li></ul><ul><li>providing an accessible, diagnostic tool suitable for worldwide use, taking into account ethnic differences </li></ul><ul><li>establishing a comprehensive ‘platinum standard’ list of additional criteria that should be included in epidemiological studies and other research into the Metabolic Syndrome </li></ul>

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