The document summarizes a presentation on metabolic syndrome in the Middle East. It discusses what metabolic syndrome is, how its diagnostic criteria and understanding have evolved over time, and its association with conditions like cardiovascular disease and erectile dysfunction. Some key points:
- Metabolic syndrome is defined as a clustering of conditions like abnormal blood glucose, dyslipidemia, obesity and high blood pressure.
- Its prevalence is increasing globally and is higher in the Middle East than Western countries, affecting over a third of populations in some Middle Eastern nations. Prevalence is higher in women.
- Metabolic syndrome is linked to a higher risk of erectile dysfunction in both men and sexual dysfunction in women. The severity of erectile and sexual
This document discusses metabolic syndrome, including its history, criteria for diagnosis, epidemiology, risk factors, complications, etiology, and prevention. Metabolic syndrome is defined as a cluster of conditions that occur together, including increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol levels. The prevalence of metabolic syndrome is high worldwide and increasing, with risk factors including older age, female gender, obesity, physical inactivity, and genetic factors. Complications of metabolic syndrome include increased risk of type 2 diabetes, cardiovascular disease, and mortality. Prevention focuses on lifestyle changes like healthy diet, exercise, and weight management.
1) A 46-year-old man with type 2 diabetes, hypertension, obesity, and dyslipidemia presented with erectile dysfunction. Laboratory tests confirmed metabolic syndrome and hypogonadism.
2) The patient meets criteria for metabolic syndrome according to NCEP-ATP III guidelines due to diabetes, hypertension, abdominal obesity, and low HDL. Hypogonadism was diagnosed based on low total testosterone, free testosterone, and bioavailable testosterone levels.
3) Guidelines recommend screening patients with diabetes and symptoms of hypogonadism for low testosterone. The patient should have been screened for erectile dysfunction due to his risk factors of diabetes and metabolic syndrome.
Metabolic Syndrome, Diabetes, and Cardiovascular Disease ... Metabolic Synd...MedicineAndFamily
This document discusses metabolic syndrome, diabetes, and cardiovascular disease. It provides an overview of diabetes prevalence in the US and shows that diabetics are at significantly higher risk of cardiovascular events like coronary disease and stroke. It then discusses insulin resistance, the natural history of type 2 diabetes, and how obesity and insulin resistance can lead to metabolic defects and increased risk of conditions like kidney disease. Lastly, it examines the prevalence of metabolic syndrome in the US according to different definitions and shows that metabolic syndrome is associated with higher rates of cardiovascular disease and mortality.
Ueda2016 metabolic syndrome in different population,which one is appropriate ...ueda2015
Metabolic syndrome is a cluster of disorders including high blood pressure, high insulin levels, excess body weight, and abnormal cholesterol that increases the risk of diseases like diabetes and heart disease. There is wide variation in the reported prevalence of metabolic syndrome across populations and definitions, and questions remain about its applicability and predictive power equally in all groups. Key determinants include obesity, especially abdominal obesity, and insulin resistance, but genetic and lifestyle factors also contribute to risk.
This document discusses metabolic syndrome, including its definition, causes, risk factors, prevalence in different populations, and treatment approaches. Metabolic syndrome is a cluster of conditions that increases the risk of cardiovascular disease and diabetes. It is characterized by abdominal obesity, high blood pressure, insulin resistance, and dyslipidemia. Lifestyle interventions like diet modification, increased physical activity, and weight loss are effective first-line treatments to reduce the risk factors of metabolic syndrome. The document reviews evidence on how different diets, exercises and weight management can help control metabolic syndrome.
The document discusses the metabolic syndrome, including its definition, major features, epidemiology, pathophysiology, approach to diagnosis, and management. Regarding management, lifestyle modifications like weight loss through calorie restriction and increased physical activity are emphasized. Pharmacological treatments and metabolic/bariatric surgery may also be considered in some cases to treat individual components of the metabolic syndrome.
Metabolic syndrome is defined as a cluster of conditions that increase the risk of cardiovascular disease and diabetes. It affects about 25% of US adults and prevalence increases with weight. The diagnostic criteria include central obesity plus two of the following: elevated triglycerides, low HDL cholesterol, high blood pressure, elevated fasting blood glucose. Central obesity, especially visceral fat, leads to insulin resistance which drives the pathogenesis. Treatment involves lifestyle modifications like diet, exercise and weight loss as well as medication for individual components such as hypertension and hyperlipidemia.
The metabolic syndrome is a constellation of conditions that increases the risk of atherosclerotic cardiovascular disease and type 2 diabetes. It is characterized by central obesity, high blood pressure, high blood sugar, high triglycerides, and low HDL cholesterol. The metabolic syndrome is caused by excess caloric intake and sedentary lifestyle and predisposes patients to insulin resistance. It affects 10-40% of adults worldwide and presents a major health challenge.
This document discusses metabolic syndrome, including its history, criteria for diagnosis, epidemiology, risk factors, complications, etiology, and prevention. Metabolic syndrome is defined as a cluster of conditions that occur together, including increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol levels. The prevalence of metabolic syndrome is high worldwide and increasing, with risk factors including older age, female gender, obesity, physical inactivity, and genetic factors. Complications of metabolic syndrome include increased risk of type 2 diabetes, cardiovascular disease, and mortality. Prevention focuses on lifestyle changes like healthy diet, exercise, and weight management.
1) A 46-year-old man with type 2 diabetes, hypertension, obesity, and dyslipidemia presented with erectile dysfunction. Laboratory tests confirmed metabolic syndrome and hypogonadism.
2) The patient meets criteria for metabolic syndrome according to NCEP-ATP III guidelines due to diabetes, hypertension, abdominal obesity, and low HDL. Hypogonadism was diagnosed based on low total testosterone, free testosterone, and bioavailable testosterone levels.
3) Guidelines recommend screening patients with diabetes and symptoms of hypogonadism for low testosterone. The patient should have been screened for erectile dysfunction due to his risk factors of diabetes and metabolic syndrome.
Metabolic Syndrome, Diabetes, and Cardiovascular Disease ... Metabolic Synd...MedicineAndFamily
This document discusses metabolic syndrome, diabetes, and cardiovascular disease. It provides an overview of diabetes prevalence in the US and shows that diabetics are at significantly higher risk of cardiovascular events like coronary disease and stroke. It then discusses insulin resistance, the natural history of type 2 diabetes, and how obesity and insulin resistance can lead to metabolic defects and increased risk of conditions like kidney disease. Lastly, it examines the prevalence of metabolic syndrome in the US according to different definitions and shows that metabolic syndrome is associated with higher rates of cardiovascular disease and mortality.
Ueda2016 metabolic syndrome in different population,which one is appropriate ...ueda2015
Metabolic syndrome is a cluster of disorders including high blood pressure, high insulin levels, excess body weight, and abnormal cholesterol that increases the risk of diseases like diabetes and heart disease. There is wide variation in the reported prevalence of metabolic syndrome across populations and definitions, and questions remain about its applicability and predictive power equally in all groups. Key determinants include obesity, especially abdominal obesity, and insulin resistance, but genetic and lifestyle factors also contribute to risk.
This document discusses metabolic syndrome, including its definition, causes, risk factors, prevalence in different populations, and treatment approaches. Metabolic syndrome is a cluster of conditions that increases the risk of cardiovascular disease and diabetes. It is characterized by abdominal obesity, high blood pressure, insulin resistance, and dyslipidemia. Lifestyle interventions like diet modification, increased physical activity, and weight loss are effective first-line treatments to reduce the risk factors of metabolic syndrome. The document reviews evidence on how different diets, exercises and weight management can help control metabolic syndrome.
The document discusses the metabolic syndrome, including its definition, major features, epidemiology, pathophysiology, approach to diagnosis, and management. Regarding management, lifestyle modifications like weight loss through calorie restriction and increased physical activity are emphasized. Pharmacological treatments and metabolic/bariatric surgery may also be considered in some cases to treat individual components of the metabolic syndrome.
Metabolic syndrome is defined as a cluster of conditions that increase the risk of cardiovascular disease and diabetes. It affects about 25% of US adults and prevalence increases with weight. The diagnostic criteria include central obesity plus two of the following: elevated triglycerides, low HDL cholesterol, high blood pressure, elevated fasting blood glucose. Central obesity, especially visceral fat, leads to insulin resistance which drives the pathogenesis. Treatment involves lifestyle modifications like diet, exercise and weight loss as well as medication for individual components such as hypertension and hyperlipidemia.
The metabolic syndrome is a constellation of conditions that increases the risk of atherosclerotic cardiovascular disease and type 2 diabetes. It is characterized by central obesity, high blood pressure, high blood sugar, high triglycerides, and low HDL cholesterol. The metabolic syndrome is caused by excess caloric intake and sedentary lifestyle and predisposes patients to insulin resistance. It affects 10-40% of adults worldwide and presents a major health challenge.
This document discusses metabolic syndrome, its causes and consequences. Metabolic syndrome is a cluster of conditions that increases the risk of heart disease, diabetes and stroke. It is becoming more common due to lifestyle factors like poor diet, lack of exercise and obesity. Refined carbs and sugar are major contributors, comprising 80-90% of the effect. Adopting a whole foods, plant-based diet has been shown to successfully treat and reverse metabolic syndrome in many cases by promoting weight loss and improving related health markers.
By Juliana C N Chan, MBChB, MD, FRCP Professor of Medicine & Therapeutics, Director, Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong, China
The document discusses the metabolic syndrome, which is a constellation of metabolic risk factors associated with increased risk of type 2 diabetes and cardiovascular disease. It explores the origins and definitions of metabolic syndrome, including the roles of genetics, environment, diet, and lifestyle factors. It also examines the clustering of metabolic syndrome risk factors and how factor analysis can be used to study these relationships between variables.
Metabolic Syndrome and Dietary Guidelines for its preventionnutritionistrepublic
The document summarizes dietary guidelines for preventing metabolic syndrome, obesity, diabetes and related disorders in Asian Indians. It recommends a diet with 50-60% calories from complex carbohydrates, 10-15% from proteins, less than 30% from total fats including less than 7% from saturated fats. It emphasizes whole grains, pulses, vegetables and fruits, moderate intake of dairy and non-vegetarian foods, and healthy cooking oils like olive and canola oil. Regular physical activity and lifestyle modifications are also recommended.
This document summarizes the history and epidemiology of diabetes. It discusses how diabetes was described historically as a melting of flesh and limbs into urine. It outlines the diagnostic criteria for diabetes according to the American Diabetes Association. It also summarizes key statistics on the rising incidence and prevalence of diagnosed diabetes in the United States from 1980 to 2010 according to the Centers for Disease Control and Prevention. Furthermore, it discusses diabetes-related complications and characteristics of chronic diseases. Lastly, it presents objectives and guidelines for diabetes prevention, control and care from Healthy People 2020 and the American Diabetes Association.
Metabolic syndrome is defined by having at least 3 of the following 5 risk factors according to the National Cholesterol Education Program Adult Treatment Panel III: abdominal obesity as measured by waist circumference, high triglyceride levels, low HDL cholesterol levels, high blood pressure, and high fasting blood glucose levels. Meeting these criteria indicates an increased risk of heart disease, stroke, and diabetes.
Metabolic Syndrome- Pathophysiology, Treatment I Insulin Resistance Syndrome ...HM Learnings
Metabolic Syndrome- Pathophysiology, Treatment I Insulin Resistance Syndrome I Endocrine Physiology
The slides will discuss the following:
1. Definition of metabolic syndrome
2. Diagnosis
3. Causes
4. Pathophysiology
5. Consequences
6. Treatment
You can also watch the same topic on HM Learnings Youtube channel.
You can also follow HM Learnings on facebook, instagram and twitter for daily updates
This document discusses metabolic syndrome, which is a cluster of risk factors for heart disease that includes diabetes, obesity, high cholesterol, and high blood pressure. It notes the increasing prevalence of metabolic syndrome in children and adolescents. While there is no consensus on diagnosing metabolic syndrome in younger populations, most agree that having two or more of the following constitutes metabolic syndrome: insulin resistance, elevated cholesterol/triglycerides, low HDL, obesity, and high blood pressure. The document focuses on insulin resistance as a unifying mechanism, exploring its relationship to excess fat, especially visceral fat, and adipocytokines like adiponectin that impact inflammation and insulin sensitivity.
The document discusses metabolic syndrome, which is characterized by insulin resistance and increased waist circumference. It is associated with dyslipidemia, glucose intolerance, hypertension, and proinflammatory cytokines. Clinical features include increased waist circumference, hypertension, and lipoatrophy. Treatment focuses on lifestyle changes like diet, physical activity, and behavior modification to address obesity, lipid levels, blood pressure, and insulin resistance.
Metabolic syndrome is a growing health concern caused by unhealthy lifestyles like poor diet and physical inactivity. The presentation summarizes diagnostic criteria for metabolic syndrome and discusses preventive strategies focused on lifestyle modifications like following a healthy diet high in fruits/vegetables and low in saturated fat, engaging in regular physical activity, managing stress, and avoiding smoking. Adopting these lifestyle changes can help prevent and treat metabolic syndrome and related diseases like diabetes and cardiovascular disease.
Metabolic syndrome is a clustering of at least three of five medical conditions that increase the risk of cardiovascular disease and diabetes. These conditions include increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol levels. Metabolic syndrome affects over 47 million Americans and is caused by risk factors such as obesity, physical inactivity, genetics, and age. Managing metabolic syndrome involves making lifestyle changes focused on diet, exercise, and stress reduction as well as medication to treat individual risk factors as needed.
This document discusses the relationship between blood pressure and metabolic syndrome. It makes three key points:
1. Several factors contribute to hypertension in metabolic syndrome, including obesity, insulin resistance, dyslipidemia, and sympathetic nervous system activation. High insulin levels and an upregulated renin-angiotensin system in adipose tissue may also play a role.
2. Insulin resistance is associated with an 11% lower risk of developing hypertension for each unit increase in insulin sensitivity. Insulin resistance can increase blood pressure through effects on vascular smooth muscle contraction, sodium reabsorption, and activation of the renin-angiotensin system.
3. Insulin resistance and hyperinsulinemia may
Guest Lecture at University of Delhi - The Entangled Relationship between Dia...Vinod Nikhra
The talk at Ramjas College, University of Delhi on 18th Feb 2015. It highlights the latest issues in biological and molecular research which link overweight/obesity with diabetes, metabolic syndrome and aging.
Metabolic syndrome is a clustering of risk factors that increase the risk of cardiovascular disease and diabetes. It is characterized by abdominal obesity, high blood pressure, elevated blood glucose, and abnormal lipid levels. The primary cause is abdominal obesity which leads to chronic inflammation and a prothrombotic state. Lifestyle changes focused on diet and exercise are the most important management strategies, while pharmacotherapy may be added if risk factors do not improve sufficiently with lifestyle changes alone.
Prevalence of obesity.Body composition & body shape (body fat distribution ) and CVD risk .Mechanisms linking obesity with cardiovascular disease.Fat-but-Fit Paradigm and CVD,The Relationship of Metabolic Risk Factors and Cardiorespiratory Fitness. Metabolically Healthy but Obese ( MHO ) Phenotype and CVD.Obesity Paradox in Patients With CVD
Resolution of Metabolic Syndrome and Morbid Obesity SurgeryGeorge S. Ferzli
This document summarizes research on the resolution of metabolic syndrome and morbid obesity through bariatric surgery procedures like Roux-en-Y gastric bypass and biliopancreatic diversion. Studies have found that both procedures effectively result in weight loss and normalization of blood glucose, lipids, blood pressure, and other metabolic markers in the majority of patients. Specifically, Roux-en-Y gastric bypass has been shown to improve markers of metabolic syndrome through changes in gastrointestinal hormones, while biliopancreatic diversion aims to limit fat and starch absorption.
Introduction, Integration of CM risk factors, Targeting obesity, Management of hypertension, Management of dyslipidemia, Antiplatelet therapy, Management of microalbuminuria, CB1 blockade
This document discusses the history and definitions of metabolic syndrome. It notes that metabolic syndrome was first described in the 1920s and involves clustering of conditions like hypertension, hyperglycemia, and hyperuricemia. In 1988, Reaven coined the term "Syndrome X" and the condition came to be recognized as involving insulin resistance. Current definitions from organizations like ATP III and IDF define metabolic syndrome as involving abdominal obesity plus two or more of the following: high triglycerides, low HDL, high blood pressure, and high fasting glucose. The document explores the links between insulin resistance, central obesity, and metabolic syndrome in driving cardiovascular and diabetes risk.
This document summarizes a teleconference on diabetes and metabolic syndrome in patients hospitalized with cardiovascular disease. It discusses screening for diabetes and metabolic syndrome in hospitalized CVD patients, defines metabolic syndrome, reviews the prevalence and risk factors associated with it, and how metabolic syndrome predicts diabetes and increased cardiovascular risk. It also reviews inpatient management of hyperglycemia and metabolic syndrome.
This document discusses metabolic syndrome, which is a combination of medical disorders that increase the risk of cardiovascular disease and diabetes when occurring together. It affects about 20% of the Malaysian population. The core components include hypertension, high triglycerides, low HDL cholesterol, obesity, and impaired glucose tolerance. There are different criteria for diagnosing metabolic syndrome, but central to all definitions is insulin resistance. If left untreated, metabolic syndrome can increase the risk of serious health conditions such as heart disease, stroke, and type 2 diabetes.
Diabetes mellitus and erectile dysfunction by Dr. Mohand Yaghi PgDip (urol) C...Mohand Yaghi
A lecture about the effect of diabetes mellitus on the erectile function. Dr. Mohand Yaghi was an invited speaker in Al-Jahra scientific day, Kuwait 2015.
This document discusses metabolic syndrome, its causes and consequences. Metabolic syndrome is a cluster of conditions that increases the risk of heart disease, diabetes and stroke. It is becoming more common due to lifestyle factors like poor diet, lack of exercise and obesity. Refined carbs and sugar are major contributors, comprising 80-90% of the effect. Adopting a whole foods, plant-based diet has been shown to successfully treat and reverse metabolic syndrome in many cases by promoting weight loss and improving related health markers.
By Juliana C N Chan, MBChB, MD, FRCP Professor of Medicine & Therapeutics, Director, Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong, China
The document discusses the metabolic syndrome, which is a constellation of metabolic risk factors associated with increased risk of type 2 diabetes and cardiovascular disease. It explores the origins and definitions of metabolic syndrome, including the roles of genetics, environment, diet, and lifestyle factors. It also examines the clustering of metabolic syndrome risk factors and how factor analysis can be used to study these relationships between variables.
Metabolic Syndrome and Dietary Guidelines for its preventionnutritionistrepublic
The document summarizes dietary guidelines for preventing metabolic syndrome, obesity, diabetes and related disorders in Asian Indians. It recommends a diet with 50-60% calories from complex carbohydrates, 10-15% from proteins, less than 30% from total fats including less than 7% from saturated fats. It emphasizes whole grains, pulses, vegetables and fruits, moderate intake of dairy and non-vegetarian foods, and healthy cooking oils like olive and canola oil. Regular physical activity and lifestyle modifications are also recommended.
This document summarizes the history and epidemiology of diabetes. It discusses how diabetes was described historically as a melting of flesh and limbs into urine. It outlines the diagnostic criteria for diabetes according to the American Diabetes Association. It also summarizes key statistics on the rising incidence and prevalence of diagnosed diabetes in the United States from 1980 to 2010 according to the Centers for Disease Control and Prevention. Furthermore, it discusses diabetes-related complications and characteristics of chronic diseases. Lastly, it presents objectives and guidelines for diabetes prevention, control and care from Healthy People 2020 and the American Diabetes Association.
Metabolic syndrome is defined by having at least 3 of the following 5 risk factors according to the National Cholesterol Education Program Adult Treatment Panel III: abdominal obesity as measured by waist circumference, high triglyceride levels, low HDL cholesterol levels, high blood pressure, and high fasting blood glucose levels. Meeting these criteria indicates an increased risk of heart disease, stroke, and diabetes.
Metabolic Syndrome- Pathophysiology, Treatment I Insulin Resistance Syndrome ...HM Learnings
Metabolic Syndrome- Pathophysiology, Treatment I Insulin Resistance Syndrome I Endocrine Physiology
The slides will discuss the following:
1. Definition of metabolic syndrome
2. Diagnosis
3. Causes
4. Pathophysiology
5. Consequences
6. Treatment
You can also watch the same topic on HM Learnings Youtube channel.
You can also follow HM Learnings on facebook, instagram and twitter for daily updates
This document discusses metabolic syndrome, which is a cluster of risk factors for heart disease that includes diabetes, obesity, high cholesterol, and high blood pressure. It notes the increasing prevalence of metabolic syndrome in children and adolescents. While there is no consensus on diagnosing metabolic syndrome in younger populations, most agree that having two or more of the following constitutes metabolic syndrome: insulin resistance, elevated cholesterol/triglycerides, low HDL, obesity, and high blood pressure. The document focuses on insulin resistance as a unifying mechanism, exploring its relationship to excess fat, especially visceral fat, and adipocytokines like adiponectin that impact inflammation and insulin sensitivity.
The document discusses metabolic syndrome, which is characterized by insulin resistance and increased waist circumference. It is associated with dyslipidemia, glucose intolerance, hypertension, and proinflammatory cytokines. Clinical features include increased waist circumference, hypertension, and lipoatrophy. Treatment focuses on lifestyle changes like diet, physical activity, and behavior modification to address obesity, lipid levels, blood pressure, and insulin resistance.
Metabolic syndrome is a growing health concern caused by unhealthy lifestyles like poor diet and physical inactivity. The presentation summarizes diagnostic criteria for metabolic syndrome and discusses preventive strategies focused on lifestyle modifications like following a healthy diet high in fruits/vegetables and low in saturated fat, engaging in regular physical activity, managing stress, and avoiding smoking. Adopting these lifestyle changes can help prevent and treat metabolic syndrome and related diseases like diabetes and cardiovascular disease.
Metabolic syndrome is a clustering of at least three of five medical conditions that increase the risk of cardiovascular disease and diabetes. These conditions include increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol levels. Metabolic syndrome affects over 47 million Americans and is caused by risk factors such as obesity, physical inactivity, genetics, and age. Managing metabolic syndrome involves making lifestyle changes focused on diet, exercise, and stress reduction as well as medication to treat individual risk factors as needed.
This document discusses the relationship between blood pressure and metabolic syndrome. It makes three key points:
1. Several factors contribute to hypertension in metabolic syndrome, including obesity, insulin resistance, dyslipidemia, and sympathetic nervous system activation. High insulin levels and an upregulated renin-angiotensin system in adipose tissue may also play a role.
2. Insulin resistance is associated with an 11% lower risk of developing hypertension for each unit increase in insulin sensitivity. Insulin resistance can increase blood pressure through effects on vascular smooth muscle contraction, sodium reabsorption, and activation of the renin-angiotensin system.
3. Insulin resistance and hyperinsulinemia may
Guest Lecture at University of Delhi - The Entangled Relationship between Dia...Vinod Nikhra
The talk at Ramjas College, University of Delhi on 18th Feb 2015. It highlights the latest issues in biological and molecular research which link overweight/obesity with diabetes, metabolic syndrome and aging.
Metabolic syndrome is a clustering of risk factors that increase the risk of cardiovascular disease and diabetes. It is characterized by abdominal obesity, high blood pressure, elevated blood glucose, and abnormal lipid levels. The primary cause is abdominal obesity which leads to chronic inflammation and a prothrombotic state. Lifestyle changes focused on diet and exercise are the most important management strategies, while pharmacotherapy may be added if risk factors do not improve sufficiently with lifestyle changes alone.
Prevalence of obesity.Body composition & body shape (body fat distribution ) and CVD risk .Mechanisms linking obesity with cardiovascular disease.Fat-but-Fit Paradigm and CVD,The Relationship of Metabolic Risk Factors and Cardiorespiratory Fitness. Metabolically Healthy but Obese ( MHO ) Phenotype and CVD.Obesity Paradox in Patients With CVD
Resolution of Metabolic Syndrome and Morbid Obesity SurgeryGeorge S. Ferzli
This document summarizes research on the resolution of metabolic syndrome and morbid obesity through bariatric surgery procedures like Roux-en-Y gastric bypass and biliopancreatic diversion. Studies have found that both procedures effectively result in weight loss and normalization of blood glucose, lipids, blood pressure, and other metabolic markers in the majority of patients. Specifically, Roux-en-Y gastric bypass has been shown to improve markers of metabolic syndrome through changes in gastrointestinal hormones, while biliopancreatic diversion aims to limit fat and starch absorption.
Introduction, Integration of CM risk factors, Targeting obesity, Management of hypertension, Management of dyslipidemia, Antiplatelet therapy, Management of microalbuminuria, CB1 blockade
This document discusses the history and definitions of metabolic syndrome. It notes that metabolic syndrome was first described in the 1920s and involves clustering of conditions like hypertension, hyperglycemia, and hyperuricemia. In 1988, Reaven coined the term "Syndrome X" and the condition came to be recognized as involving insulin resistance. Current definitions from organizations like ATP III and IDF define metabolic syndrome as involving abdominal obesity plus two or more of the following: high triglycerides, low HDL, high blood pressure, and high fasting glucose. The document explores the links between insulin resistance, central obesity, and metabolic syndrome in driving cardiovascular and diabetes risk.
This document summarizes a teleconference on diabetes and metabolic syndrome in patients hospitalized with cardiovascular disease. It discusses screening for diabetes and metabolic syndrome in hospitalized CVD patients, defines metabolic syndrome, reviews the prevalence and risk factors associated with it, and how metabolic syndrome predicts diabetes and increased cardiovascular risk. It also reviews inpatient management of hyperglycemia and metabolic syndrome.
This document discusses metabolic syndrome, which is a combination of medical disorders that increase the risk of cardiovascular disease and diabetes when occurring together. It affects about 20% of the Malaysian population. The core components include hypertension, high triglycerides, low HDL cholesterol, obesity, and impaired glucose tolerance. There are different criteria for diagnosing metabolic syndrome, but central to all definitions is insulin resistance. If left untreated, metabolic syndrome can increase the risk of serious health conditions such as heart disease, stroke, and type 2 diabetes.
Diabetes mellitus and erectile dysfunction by Dr. Mohand Yaghi PgDip (urol) C...Mohand Yaghi
A lecture about the effect of diabetes mellitus on the erectile function. Dr. Mohand Yaghi was an invited speaker in Al-Jahra scientific day, Kuwait 2015.
Intermittent fasting and metabolic syndromefathi neana
Dr. Fathi Neana discusses metabolic syndrome and its impact on the musculoskeletal system. Metabolic syndrome is reaching epidemic proportions and is associated with obesity, diabetes, gout, and other conditions that can cause surgical difficulties and complications. Intermittent fasting is presented as a potential strategy for correcting metabolic abnormalities and managing conditions associated with metabolic syndrome like type 2 diabetes.
Erectile dysfunction (ED) is common, affecting over 150 million men worldwide. It is a marker for other neurovascular complications in diabetes. The causes of ED include vascular, neurological, endocrine, and psychological factors. Treatments include oral phosphodiesterase type 5 inhibitors, vacuum devices, intracavernosal injections, testosterone replacement, and psychosexual counseling. Managing associated conditions and hormonal deficiencies can effectively treat ED.
Martin Banschbach presented on the nutritional aspects of metabolic syndrome. He discussed how pushing glucose or fructose into the liver can lead to abdominal obesity and metabolic syndrome. The presentation covered how different starches are digested at different rates based on their amylose and amylopectin content. A low glycemic diet can help lower blood glucose and HbA1c levels. Choosing foods with a low glycemic load using resources like NutritionData.com can help manage metabolic syndrome.
This document is a thesis submitted by Andrew C. Hall to Oklahoma State University in partial fulfillment of the requirements for a Master of Science degree in Health and Human Performance in July 2014. The thesis examines the effectiveness of a 12-week fitness intervention for individuals diagnosed with metabolic syndrome. Eleven adults participated in the study, which involved moderate intensity aerobic exercise 3 times per week for 30 minutes, gradually increasing the intensity over 12 weeks. The thesis measured various health markers before and after the intervention to determine the impact on risk factors for metabolic syndrome. It found significant improvements in several areas, including weight, abdominal girth, flexibility, and muscular endurance. However, it did not find significant changes in all risk factors. The study
This document discusses the developmental origins of childhood and adult obesity. It summarizes trends showing increasing rates of obesity, hypertension, and diabetes in the US population. Animal and human studies suggest that poor maternal nutrition, either overnutrition or undernutrition, can program the fetus for obesity and metabolic syndrome later in life. This is due to alterations in the development of appetite regulating regions in the hypothalamus.
The document summarizes research on skin manifestations of endocrine disorders. Two studies found that hirsutism and acanthosis nigricans are reliable signs of polycystic ovary syndrome in women, and that post-adolescent males with acne have higher rates of insulin resistance. The document also reviews other conditions like Cushing's disease, hypothyroidism, and congenital adrenal hyperplasia that can cause skin abnormalities through excess androgen production. It provides details on evaluating and treating patients with skin signs of endocrine disorders.
Hirsutism _ excesive terminal hair growth in the women on a male pattern distribution-face, body(sexual hear,androgendependent)-common in PCOS
Hypertricosis_ can involve of vellus, lanugo, nonpigmanted hair and terminal hear occupying the entire body surface including the face ( androgen independent disorder)- congenital, caused by drugs, hypothyroidism, anorexia nervosa
Virilization _ production of androgens in women is extremely high (presence of clitoromegaly,alopecia- balding, deepening of the voice- bariphonia, male body habitus)-usually caused by androgen producing tumors, CAH
Acne _ du to hyperceratosis and occlusion of duct of sebaceum gland plus inflammation( multifactoral, androgendependent)
Acanthosis nigricans _ skin grey- brown ,velvety appearance mainly in the neck, axillae,vulva and groin (local hyperpigmentation of skin on specific area-marker of hyperinsulinemia/insulinresistance)
This document summarizes erectile dysfunction (ED), including its causes, evaluation, and treatment options. It discusses factors like vascular disease, medications, and psychological issues that can cause ED. Evaluation involves history, physical exam, lab tests, and imaging. Treatment includes lifestyle changes, medications like PDE5 inhibitors, penile prosthetics, surgery, and emerging options like gene therapy and new drugs. The conclusion emphasizes treating the underlying cause and that PDE5 inhibitors are generally safe while new drugs are promising.
This document provides a literature review on the metabolic syndrome and the effects of resistance training on risk factors for the metabolic syndrome. It begins with definitions and descriptions of the metabolic syndrome, its components, diagnosis, prevalence, and pathophysiology. It then discusses resistance training and its effects on strength, muscle mass, and disease prevention in the elderly population. The literature review examines the effects of resistance training on insulin resistance, abdominal obesity, blood pressure, lipid profile, and potential mechanisms of effect. It notes inconsistencies in findings and questions about clinical significance. The aim of the study is to investigate the effects of a short-term, high-repetition resistance training protocol on metabolic syndrome risk factors in elderly adults.
This document discusses antihyperlipidemic drugs used to treat hyperlipidemia. It begins by defining hyperlipidemia and describing risk factors. It then covers the various classes of lipid-lowering drugs including HMG-CoA reductase inhibitors (statins), bile acid sequestrants, fibrates, nicotinic acid, cholesterol absorption inhibitors, and PCSK9 inhibitors. For each class, it provides examples of drugs, their mechanisms of action, therapeutic uses, and major side effects and drug interactions. The document concludes with recommendations on drug therapy and monitoring treatment effectiveness.
This document discusses virilization and hirsutism. It defines virilization as clinical features associated with high male hormones in women, such as hirsutism, acne, deepening of voice, increased muscle mass and breast atrophy. Hirsutism is specifically defined as excessive hair growth in a male pattern in women. Potential causes of hirsutism include polycystic ovarian syndrome, congenital adrenal hyperplasia, exogenous androgen use, and androgen-secreting tumors. The document provides details on evaluating potential causes and treating hirsutism.
Management of Hyper-Androgenism: MADE EASY-Life Care Centre_Dr.Sharda JainLifecare Centre
Management of Hyper-Androgenism: MADE EASY
Dr.Sharda Jain
Life Care Centre
-ACNE
-Virilization
-Hirsuitism
-PCOD
-Combined Oral Pills
-Polycystic Ovary Syndrome
-Congenital Adrenal Hyperplasmia
Erectile Dysfunction: New Paradigms in Treatment Ranjith Ramasamy
1. Discuss diagnosis of erectile dysfunction
2. Treatments of ED using Viagra, Cialis, Trimix (intracavernosal injections)
3. Evaluate penile prosthesis and implant as ED surgical therapy options
This document discusses the metabolic side effects of drugs used in psychiatry. It begins by defining metabolic syndrome and describing the classification of antipsychotic drugs. It then discusses the historical recognition of metabolic and cardiovascular side effects of first-generation antipsychotics. Several studies are summarized that show associations between various antipsychotic drugs and risks of diabetes, metabolic syndrome, cardiovascular effects, and hyperprolactinemia. Risks are compared between different drug classes and specific antipsychotics. Management of metabolic abnormalities is also briefly addressed.
This document describes different types of antihyperlipidemic drugs used to treat various types of hyperlipidemias. It discusses the mechanisms and side effects of niacin, fibrates like gemfibrozil and clofibrate, bile acid sequestrants like cholestyramine, statins which inhibit HMG CoA reductase, and ezetimibe which inhibits cholesterol absorption. The types of hyperlipidemia and appropriate drug therapies are outlined.
This document summarizes various classes of antihypertensive drugs including diuretics, sympatholytic agents, adrenergic receptor blockers, direct vasodilators, calcium channel blockers, angiotensin converting enzyme inhibitors, and their mechanisms of action, therapeutic uses, and side effects. It also provides guidelines on the management of hypertension including recommendations for first-line drugs for mild or moderate vs. severe hypertension as well as considerations for special populations and hypertensive emergencies.
Diabetes is associated with sexual dysfunction in both men and women. In men, erectile dysfunction is much more common, with a threefold increased risk. The risk increases with age. In women, female sexual dysfunction is also more prevalent among those with diabetes. Risk factors include poor glycemic control, cardiovascular disease, and psychological issues. Treatment involves lifestyle modifications, medication management, and counseling or therapy.
This study assessed the prevalence of metabolic syndrome in men with normal and abnormal semen parameters. Of 526 men studied, 26.5% had metabolic syndrome, higher than the general population prevalence of 18%. However, the prevalence of metabolic syndrome was not significantly different between men with normal versus abnormal semen parameters. While obesity and metabolic syndrome may impact fertility in women, this study found metabolic syndrome did not appear to have a major effect on male fertility or semen parameters. Larger longitudinal studies are still needed to understand potential effects over time.
This document provides an overview of polycystic ovarian syndrome (PCOS), including its history, diagnostic criteria, pathophysiology, health risks, infertility issues, and treatment approaches. PCOS is a common endocrine disorder affecting 2-8% of women. It is characterized by irregular periods, excess androgen levels, and polycystic ovaries. Insulin resistance and obesity are strongly associated with PCOS and contribute to its metabolic complications. Lifestyle changes like diet and exercise can help manage symptoms and improve fertility outcomes in many women.
Women face greater risks from coronary artery disease than men. CAD is a leading cause of death in women worldwide. While women tend to develop CAD approximately 10 years later than men, they are more likely than men to die within a year of a heart attack. Women often experience different symptoms than men and are less likely to receive timely diagnosis and treatment. Risk factors like diabetes, smoking, and autoimmune diseases confer greater relative risks for CAD in women. There remains a need for greater awareness of heart disease in women and more tailored screening and management strategies.
The document discusses the metabolic consequences of polycystic ovary syndrome (PCOS), including insulin resistance and risk of diabetes. Women with PCOS have increased insulin resistance compared to controls, which can lead to hyperinsulinemia and compensatory hyperinsulinemia from the beta cells. Insulin resistance and secretion defects are seen in both obese and lean PCOS women. Over time, persistent insulin resistance can cause beta cell dysfunction and increased risk of impaired glucose tolerance or type 2 diabetes. Lifestyle changes like 5-10% weight loss and medication like metformin can help manage insulin resistance and lower diabetes risk in PCOS.
A group of physiological abnormalities such as an increase in blood pressure, diabetes, increase in cholesterol levels and obesity is known as Metabolic Syndrome. Women in their pregnancy period are highly prone to this problem. Doctors are taking the issue of metabolic syndrome in obstetric practice seriously as it may risk the pregnancy.
Obesity in male infertility by dr. sharda jain, Dr. Jyoti Agarwal, Dr. Jyoti ...Lifecare Centre
This document discusses how obesity reduces fertility in men. It finds that obese men are about twice as likely to be infertile as men of normal weight. Obesity is associated with decreased sperm count and quality, including lower sperm motility and morphology. The mechanisms by which obesity harms male fertility include increased oxidative stress, hormonal imbalances and hypogonadism, and the accumulation of compounds that interfere with fertility. Losing even 5-10% of body weight through diet and exercise can help improve semen quality and fertility outcomes. Assisted reproduction techniques like ICSI may also help obese men who struggle with infertility.
This document discusses the consequences of cancer treatment and late effects. It notes that late effects currently affect 400,000 people in the UK and have a significant impact on survivors' daily lives. Late effects are underappreciated and can be managed through early intervention to prevent long-term impacts. The risks of late effects depend on treatment factors like radiation dose and chemotherapy drugs, as well as individual patient factors. Common late effects include scarring, functional disability, lymphedema, cardiac issues, and gastrointestinal problems. The document calls for improved assessment, management, and services to address late effects.
This document discusses possible links between vitamin D deficiency and various geriatric syndromes and common comorbidities. It begins by outlining how vitamin D receptors are present in many tissues beyond the musculoskeletal system. It then examines potential associations between vitamin D deficiency and increased risks of frailty, urinary incontinence, dementia/cognitive impairment, and depression in elderly populations. While evidence is limited and relationships are not clearly causal, several observational studies have found correlations between low vitamin D levels and higher rates of these conditions. More research is still needed, but maintaining adequate vitamin D status may help reduce risks of age-related diseases and functional decline.
CORONARY ARTERY DISEASE IN WOMEN by DR ABHISHEK RATHOREdrabhishekbabbu
CAD is the leading cause of death in women. Here is the current scenerio of CAD in women. In what matter CAD in women differs from man is presented hare.
The document discusses the high prevalence and negative impacts of depression among those with diabetes, as depression is associated with worse diabetes outcomes and control. It reviews epidemiological data showing the bidirectional relationship between depression and diabetes. Several studies cited find associations between depression and longer diabetes duration or poorer glycemic control.
Androgens & Cardiovascular Diseases in Women: From Basic Research to Clinical...InsideScientific
Join Dr. Licy Yanes-Cardozo as she expands on her research exploring the role of androgens on cardiovascular physiology in cis and transgender patients.
Women have higher plasma concentrations of androgens than estrogens, yet the role of androgens in physiological processes and diseases is not completely understood. High levels of androgens in women are associated with a negative cardiometabolic profile, whereas in men, low levels of androgens are associated with an increased incidence of cardiovascular diseases.The biology behind androgens’ sex difference is not completely understood.
In this webinar, Dr. Yanes-Cardozo discusses two clinical situations that are associated with high levels of androgens. Polycystic Ovary Syndrome (PCOS), the most common endocrine disorder in reproductive-aged women, is associated with a modest elevation of plasma levels of androgens. In transmen individuals (female to male), plasma concentrations of androgens are elevated to achieve similar levels found in cisgender men and much higher than in PCOS women. The role that these two different plasma concentrations play in cardiovascular physiology and pathophysiology remains unclear. Gaps and opportunities in basic research and clinical practice are highlighted.
Key Topics Include:
- Review the key role of androgens in cardiovascular pathophysiology
- Discuss potential mechanisms by which androgens mediate a deleterious cardiometabolic profile in females
- Interpret gaps and opportunities in basic and clinical practice in conditions of androgen excess
Introduction: The objective of this work is to study the epidemiological and clinical aspects of erectile dysfunction in a population of diabetic patients in the Thies region.
This document discusses the relationship between non-alcoholic fatty liver disease (NAFLD) and cardiovascular disease. Some key points:
- NAFLD is one of the most common forms of liver disease, affecting 10-24% of the general population. It is strongly associated with obesity and metabolic syndrome.
- Patients with NAFLD have a higher risk of cardiovascular diseases like atherosclerosis, the leading cause of mortality. NAFLD is linked to traditional risk factors as well as surrogate markers for cardiovascular disease.
- Epicardial fat thickness, as measured by echocardiography, is increased in patients with NAFLD and metabolic syndrome. Increased epicardial fat is associated with atherosclerosis
Learn about the connection between Polycystic Ovary Syndrome (PCOS) and Metabolic Syndrome. Discover symptoms, associated risks, and effective management strategies to improve your health and well-being.
1) Obesity rates have doubled worldwide in the past few decades and over 1 billion people are now overweight or obese globally.
2) Developing countries are beginning to experience nutrition transitions where physical activity levels decrease and diets become more calorie-dense, leading to growing obesity problems.
3) Bariatric surgery is an effective treatment for severe obesity, resulting in over 60% excess weight loss on average and resolution of related health conditions like diabetes and hypertension for the majority of patients.
Simply applying knowledge we have reliably in hand, we could prevent fully 80% of all chronic disease and premature death in modernized and modernizing countries. Standing between us and that prize is an obstacle course of competing claims, false promises, and profit-driven, pop culture nonsense. The case will be made for True Health Coalition to rally diverse voices to the cause of using what we know, even as we pursue what we do not. The challenges, operations, and promise of the endeavor will be discussed.
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TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
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- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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Metabolic syndrome and erectile dysfunction
1. 2ND BIENNIAL MEETING OF THE
MIDDLE EAST SOCIETY FOR SEXUAL
MEDICINE
Metabolic Syndrome in
the Middle East
Tarek Anis, M.D.
Prof. of Andrology, Cairo University
3. What is Metabolic Syndrome ?
The metabolic syndrome refers to a clustering
of various medical conditions, with a number
of pathological components, that contribute to
the development of cardiovascular diseases
and diabetes.
These pathological components include
blood glucose abnormality, dyslipidemia,
visceral fat accumulation and elevated blood
pressure
4. Evolution of the Metabolic
Syndrome
The Adult Treatment Panel of
the National Cholesterol
Education Program.
World Health
(NCEP ATPIII)
Organisation (WHO)
The International
Diabetes Federation
(IDF)
3
1
1998 1999 2000
2
The European Group for
the Study of Insulin
Resistance (EGIR)
2001
5
2002
2003
2004
4
The American
Association of Clinical
Endocrinologists (AACE)
2005
6
The American Heart
Association (AHA/NHLBI)
Hanefeld and Leonhardt in 1981 were the first to use the term
“Metabolic Syndrome”
5. Diagnostic Criteria for
Metabolic Syndrome in Men
WHO 1999
World Health Organization
NCEP–ATP III
2001
IDF 2005
The International Diabetes
Federation
The National
Cholesterol Education
Program
Glucose
abnormality
Obesity
FBS ≥ 110 mg/dL
Type 2 DM
0.90
Waist/Hip ratio >
WC ≥ 102 cm
WC ≥ 94 cm
BMI ≥ 30 kg/m2
Type 2 DM
FBS > 100 mg/dL
Central obesity (ethnic
specific values)*
Europids ≥94cm - Asians
>90cm
≥ 150 mg/dL
≥ 150 mg/dL
< 35 mg/dL
< 40 mg/dL
< 35 mg/dL
BP ≥ 140/90 mmHg
BP ≥ 130/85
mmHg
Systolic BP ≥ 130
mmHg
↑ Triglyceride
↓ HDL
Cholesterol
↑ Blood
Pressure
FBS > 110
mg/dL
↑ insulin or IR
Type 2 DM
or HTN on Rx
or HTN on Rx
If BMI is >30 kg/m², central obesity can be assumed and waist circumference does not
≥ 150 mg/dL or on
specific treatment
Diastolic BP ≥ 85 mmHg
or HTN to be
need on Rx measured
Traish AM, Guay A, Feeley R, Saad F. The dark side of testosterone deficiency: I. Metabolic syndrome
and erectile dysfunction. J Androl 2009 Jan-Feb; 30 (1): 10-22.
6. Risks and Associated
Conditions
Cardiovascular disease
Type 2 diabetes mellitus
Non alcoholic fatty liver disease
Polycystic ovarian syndrome
Obstructive sleep apnea
Hypogonadism and erectile dysfunction
Grundy S. 2008 : Metabolic Syndrome Pandemic. Arterioscler. Thromb. Vasc. Biol 28;629-636
8. Global Prevalence of Metabolic
Syndrome
The age-adjusted prevalence in US and Europe is ≈ 26%
The prevalence is ≈ 20% in Africa and Asia
The prevalence of the syndrome is strongly related to age.
At the age of 20 years ≈ 7% and at the age of 60 ≈ 40%
Men and women are affected about equally
The prevalence is increasing
1- Grundy et al. 2008 : Metabolic Syndrome Pandemic. Arterioscler. Thromb. Vasc. Biol. 28;629-636
2- Ford ES, Giles WH, Mokdad AH. Increasing prevalence of the metabolic syndrome among U.S. Adults. Diabetes
Care. 2004;27:2444 –2449.
3- Al-Daghri NM, Al-Attas OS, Alokail MS, Alkharfy KM, Sabico SLB, et al. (2010) Decreasing Prevalence of the Full
Metabolic Syndrome but a Persistently High Prevalence of Dyslipidemia among Adult Arabs. PLoS ONE 5(8): e12159.
doi:10.1371/journal.pone.0012159
9. Age-Specific Prevalence of the
Metabolic Syndrome
Prevalence %
Prevalence of the Metabolic Syndrome Among 8814 US
Adults
Ford et al, 2002 : Prevalence of the Metabolic Syndrome Among US Adults. Findings From the Third National Health
and Nutrition Examination Survey. JAMA. 2002;287:356-359
10. Prevalence of Metabolic is
Increasing
Two factors appear to account for the global
increase:
Obesity increase
The prevalence of obesity in the US increased from
22.5% to 32% between 1994 and 2007.
Ageing of the population
The prevalence of the MetS increases with age
increase. This effect can be explained largely by agerelated rises of blood pressure and blood glucose
Grundy S. 2008 : Metabolic Syndrome Pandemic. Arterioscler. Thromb. Vasc. Biol 28;629-636
11. Prevalence of Metabolic Syndrome in the
United States, 1999 to 2010
Beltrá
n-Sá
nchez, et al 2013: Prevalence and Trends of Metabolic Syndrome in the Adult U.S. Population, 1999–
2010, J Am Coll Cardiol. 62(8):697-703
13. Prevalence of Metabolic
Syndrome in the Middle East
Turkey
33.
higher prevalence in women
9% (39.6%) than in men (28%)
2108 men and
2151 women
Tunisia
45.
higher prevalence in women
5% than in men
1244 men and
2191 women
39.
higher prevalence in women
3% (42%) than in men (37.2%)
17,293 (30–70
years)
Jordan
36.
higher prevalence in women
3% (40.9%) than in men (28.7%)
1121 northern
Jordanians
U.A.E
40.
5%
4097 men and
women
Kozan et al, 2007
2007
Bouguerra et al,
Saudi
Arabia
2005
Al-Nozha et al,
Khader et al, 2007
Malik &
Razig , 2008
46.
Qatar
Sliem HA, Ahmed S, Nemr N, El-Sherif I. : Metabolic syndrome in the Middle East., Indian136 adultsMetab.
J Endocrinol
Ismael, 2012
3% males (42.4%)
2012 Jan;16(1):67-71
higher in females (50%) than in
14. Prevalence of Metabolic
Sydrome in the Middle East
Prevalence is higher than the western countries.
Prevalence is increasing.
Female prevalence is higher than the male prevalence
Physical and cultural barriers to physical activity
Climatic conditions of extreme heat in the summer
Limited exercise facilities devoted solely for women
Lack of physical education or an emphasis on its
importance in schools
Absence of women's participation in organised sports
Sliem HA, Ahmed S, Nemr N, El-Sherif I. : Metabolic syndrome in the Middle East., Indian J Endocrinol Metab.
2012 Jan;16(1):67-71
21. High prevalence of Erectile
Dysfunction in Men with the Metabolic
Syndrome
26.7%
Men with
Metabolic syndrome
13%
Control Group
matched for age and BMI
Esposito K, Giugliano F, Martedi E, Feola G, Marfella R, D’Armiento M, Giugliano D. High proportions of erectile
dysfunction in men with the metabolic syndrome. Diabetes Care 2005;28:1201–3
22. (IIEF <21)
prevalence of ED
The Prevalence of ED increases as
the Severity of MetS Increases
Esposito K, Giugliano F, Martedi E, Feola G, Marfella R, D’Armiento M, Giugliano D. High proportions of erectile
dysfunction in men with the metabolic syndrome. Diabetes Care 2005;28:1201–3
23. Men with Metabolic Syndrome
Have Reduced IIEF-EF Score
IIEF-EF Score
268 patients, 89 (33%) with metabolic syndrome
Demir T. Prevalence of erectile dysfunction in patients with metabolic syndrome. Int J Urol 2006; 13:385–8.
24. The relationship between
Metabolic Syndrome and severity
of ED
Incidence of ED
393 urological patients, 39.9% met MetS criteria
Bal et al 2007. Prevalence of Metabolic Syndrome and Its Association with Erectile Dysfunction Among Urologic Patients:
Metabolic Backgrounds of Erectile Dysfunction. Urology , Volume 69 , Issue 2 , Pages 356 - 360
25. Prevalence of
metabolic syndrome
Prevalence of Metabolic
Syndrome in Men with Organic
ED
Bansal TC, Guay AT, Jacobson J, Woods BO, Nesto RW. Incidence of metabolic syndrome and
insulin resistance in a population with organic erectile dysfunction. J Sex Med. 2005; 2: 96-103
26. Prevalence of
metabolic syndrome
The Relationship between Severity of
ED and the Prevalence of Metabolic
Syndrome
Sexual Health Inventory for Men
Bansal TC, Guay AT, Jacobson J, Woods BO, Nesto RW. Incidence of metabolic syndrome and insulin resistance in a
population with organic erectile dysfunction. J Sex Med. 2005; 2: 96-103
27. The Relationship between Severity of ED
and the Prevalence of MetS in men with
low Testosterone
García-Cruz E, Leibar-Tamayo A, Romero J, Piqueras M, Luque P, Cardeñ osa O, and Alcaraz A. Metabolic
syndrome in men with low testosterone levels: Relationship with cardiovascular risk factors and comorbidities and
with erectile dysfunction. J Sex Med 2013;10:2529–2538
29. Sexual Dysfunction among
Postmenopausal Women
Percentage of women with sexual dysfunction (FSFI score <23)
103 women with the
metabolic syndrome
105 matched
control women
Martelli V, Valisella S, Moscatiello S, Matteucci C, Lantadilla C, Costantino A, Pelusi G, Marchesini G, and Meriggiola
MC. Prevalence of sexual dysfunction among postmenopausal women with and without metabolic syndrome. J Sex
Med 2012;9:434–441.
30. Prevalence of pathological scores
Female Sexual Function Index
Domains
Martelli et. al., Prevalence of sexual dysfunction among postmenopausal women with and without metabolic syndrome
J Sex Med 2012;9:434–441.
31. Women with Metabolic
Syndrome Have Reduced FSFI
Score
FSFI score
120 women with metabolic syndrome and 80
matched control
Esposito K, Ciotola M, Marfella R, Di Tommaso D, Cobellis L, Giugliano D. The metabolic syndrome: a cause
of sexual dysfunction in women. Int J Impot Res 2005 May-Jun; 17 (3): 224-6.
32. Female Sexual Function Index
FSFI Decrease with increase of
Metabolic Syndrome Severity
Esposito K, Ciotola M, Marfella R, Di Tommaso D, Cobellis L, Giugliano D. The metabolic syndrome: a cause of sexual
dysfunction in women. Int J Impot Res 2005 May-Jun; 17 (3): 224-6.
34. The Pathogenesis of ED in
Metabolic Syndrome
Food intake ↑
Gene
Activity ↓
Visceral obesity
↓ Androgen
Insulin resistance
Sodium
retention
↑Sympathetic
activity
Oxidative
Stress
Aging
Atherosclerosis
Suetomi et al. Negative impact of metabolic syndrome on the responsiveness to sildenafil in Japanese men. J Sex Med 2008;5:1443–1450
35. Men with Metabolic Syndrome
Have Impaired Endothelial
Function
Endothelial function score
blood pressure and platelet aggregation responses to L-Arginine (3 g i.v.)
n = 100
n = 50
Esposito K, Giugliano F, Martedi E, Feola G, Marfella R, D’Armiento M, Giugliano D. High proportions of erectile
dysfunction in men with the metabolic syndrome. Diabetes Care 2005;28:1201–3
36. Men with Metabolic Syndrome
Have Impaired Endothelial
Function
Endothelium-dependent vasodilation
Endothelium-dependent
vasodilation
Change of forearm blood flow in response to infusion of 50g/min of
acetylcholine
Lind L, Endothelium-dependent vasodilation, insulin resistance and the metabolic syndrome in an elderly cohort:
the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS) study. Atherosclerosis. 2008
Feb;196(2):795-802
37. Men with Metabolic Syndrome
Have Impaired Endothelial
Function
Endothelium-dependent vasodilation
Change of forearm blood flow in response to infusion of 50g/min of acetylcholine
Lind L, Endothelium-dependent vasodilation, insulin resistance and the metabolic syndrome in an elderly cohort: the
Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS) study. Atherosclerosis. 2008 Feb;196(2):795-802
39. Testosterone and Metabolic
Syndrome
A systematic review
was performed
including all
prospective and crosssectional studies,
comparing T levels in
subjects with or without
MetS
13 properly performed
studies were identified
Corona G, Monami M, Rastrelli G, Aversa A, Tishova Y, Saad F, Lenzi A, Forti G, Mannucci E, Maggi M.
Testosterone and metabolic syndrome: a meta-analysis study. J Sex Med 2011; 8 (1): 272-83
40. Incidence of Hypogonadism
in Metabolic Syndrome
Patients
1,134 men
with sexual
dysfunction
Metabolic syndrome
No metabolic syndrome
Corona G, Mannucci E, Petrone L, Balercia G, Paggi F, Fisher AD, Lotti F, Chiarini V, Fedele D, Forti G, Maggi M.
NCEP-ATPIII-defined metabolic syndrome, type 2 diabetes mellitus, and prevalence of hypogonadism in male patients
with sexual dysfunction. J Sex Med 2007; 4 (4 Pt 1): 1038-45.
41. 803 patients
with sexual
dysfunction
mean and 95% confidence interval
Total Testosterone (nM)
Relationship Between Total Testosterone
and the Number of Metabolic Syndrome
Components
(29.4%)
diagnosed as
having a MS
Number of Metabolic syndrome Components
Corona G, Mannucci E, Schulman C, Petrone L, Mansani R, Cilotti A, Balercia G, Chiarini V, Forti G, Maggi M.
Psychobiologic Correlates of the metabolic syndrome and associated sexual dysfunction. Eur Urol. 2006; 50: 595-604
42. Number of Metabolic syndrome
Components
Relative Risk for Hypogonadism
According to the Number of MetS
Components
1
2
3
4-5
♦
♦
803 patients with
sexual dysfunction
♦
♦
Relative risk for hypogonadism
Corona G, Mannucci E, Schulman C, Petrone L, Mansani R, Cilotti A, Balercia G, Chiarini V, Forti G, Maggi M.
Psychobiologic Correlates of the metabolic syndrome and associated sexual dysfunction. Eur Urol. 2006; 50: 595-604
43. Odds ratio for hypogonadism in
metabolic syndrome patients
Elevated BP
♦
♦
♦
Elevated Fasting Glucose
Elevated Waist circumference
Reduced HDL-C
Elevated Triglycerides
♦
♦
Odds ratio for hypogonadism
Corona G, Mannucci E, Schulman C, Petrone L, Mansani R, Cilotti A, Balercia G, Chiarini V, Forti G, Maggi M.
Psychobiologic Correlates of the metabolic syndrome and associated sexual dysfunction. Eur Urol. 2006; 50: 595-604
44. Metabolic Syndrome and
Hypogonadism
Adopted from Jones T. 2007 : Testosterone Associations with Erectile Dysfunction, Diabetes, and the Metabolic
Syndrome. European Urology Supplements. Volume 6, Issue 16, 847-857
45. Androgens Maintain Penile Tissues
Structure and Function
Androgens maintain vascular endothelial structure and
function
Androgens maintain tunica albuginea structural integrity
and connective tissue matrix fibro-elastic properties
Androgens regulate differentiation of pluripotent precursor
cells into trabecular smooth muscle, and maintain smooth
muscle structure and function
Androgens maintain penile cavernosal and dorsal nerves
structure and function
Traish,AM, 2008. Androgens Play a Pivotal Role in Maintaining Penile Tissue Architecture and Erection: A Mini
Review. Published-Ahead-of-Print on September 18, 2008 by Journal of Andrology
46. Testosterone Restores PDE5 Inhibitors
Responsiveness in Hypogonadal Patients
with Erectile Dysfunction
Authors
No. of
subjects
Hypogona
dism
Sildenafil
response at
baseline
Overall
efficacy
Aversa et al.
20
No
Failure
80%
Kalinchenko
et al.
120
Yes
Failure
70%
Shabsigh et
al.
75
Yes
Failure
70%
Chatterjee et
al.
12
Yes
Not evaluated
100%
Shamloul et
al.
40
PADAM
Failure
Improve
d
Greenstein et
al.
49
Yes
Not evaluated
63%
Hwang et al.
32
Yes
Failure
57%
Adopted from Greco EA, Spera G, Aversa A: Combining testosterone and PDE5 inhibitors in erectile dysfunction:
Rosenthal et
basic rationale and clinical evidences. Eur Urol. 2006 Nov;50(5):940-7
24
Yes
Failure
92%
al.
47. Obesity: New Aspects
For a long time adipose tissue was considered to
be an inactive reserve depot of fat.
It is now recognized that adipose tissue is an
active tissue, directly involved in the control of
body weight and energy balance via the secretion
of a large number of molecules with regulatory
potential (adipokines)
48. Adipocytokine
Adipocytokine is a general
term for a bioactive product
produced by adipose tissue.
They include
- Inflammatory mediators (IL6, IL-8)
- Angiogenic proteins (VEGF)
- Metabolic regulators
(adiponectin; leptin)
Gooren L., Obesity: new aspects. Journal of Men's Health. Volume 5, Issue 3, September 2008, Pages 249-256
49. Adipocytokine
They include inflammatory mediators (IL-6, IL-8),
angiogenic proteins (VEGF), and metabolic regulators
(adiponectin; leptin).
Not all white adipose tissue is metabolically equivalent.
Visceral adipose tissue, due in part to its association
with the hepatic portal venous system, appears to be a
critical regulator of glucose and fat metabolism.
Subcutaneous adipose tissue appears to be the
principal source of leptin and adiponectin
50. Adipocytokines
The production by the liver of C reactive
protein is triggered by various proinflammatory cytokines derived from numerous
sources, such as macrophages, monocytes,
and adipose tissue.
Several large population studies have
indicated that biomarkers of inflammation
predict an increased risk for cardiovascular
diseases including ED.
Gooren L., Obesity: new aspects. Journal of Men's Health. Volume 5, Issue 3, September 2008, Pages 249-256
51. Sex Differences in Fat
Distribution
Adult men and women differ in their fat distribution
Breast
Hips
Thighs
abdominal
region
(both subcutaneous and
visceral)
Men generally have a larger visceral fat depot than (premenopausal) women
52. Sex Differences in Fat
Distribution
Since regional localization of body fat is
considered to be a secondary sex characteristic,
it is likely that sex steroids are involved in the
male and female patterns of fat deposition
Until puberty, boys and girls do not differ very
much in the amount of body fat and its regional
distribution
53. Sex Differences in Fat
Distribution
The ovarian production of estrogens and
progesterone at puberty induces an increase in total
body fat as well as selective fat deposition in the
breast and gluteo-femoral region.
Adolescent boys lose subcutaneous fat but
accumulate fat in the abdominal region, which in most
boys is not very visible at that stage of development
but is clearly demonstrable using imaging techniques.
Roemmich JN, Clark PA, Mai V, Berr SS, Weltman A, Veldhuis JD, et al. Alterations in growth and body
composition during puberty: III. Influence of maturation, gender, body composition, fat distribution, aerobic fitness,
and energy expenditure on nocturnal growth hormone release. J Clin Endocrinol Metab 1998;83(5): 1440–7.
54. The paradoxical relationships of
testosterone and fat distribution in
adulthood and aging
Adult onset hypogonadism in men is associated with
increase of visceral fat.
While androgens induce visceral fat accumulation at
puberty, once fat has been stored in the visceral depot
it does not need continued androgen stimulation, in
contrast to the maintenance of bone and muscle mass,
which are lower in men with adult onset hypogonadism
than in eugonadal controls.
Katznelson L, Rosenthal DI, Rosol MS, Anderson EJ, Hayden DL, Schoenfeld DA, et al. Using quantitative CT to assess adipose
distribution in adultmen with acquired hypogonadism. Am J Roentgenol 1998;170(2): 423–7.
Katznelson L, Finkelstein JS, Schoenfeld DA, Rosenthal DI, Anderson EJ, Klibanski A. Increase in bone density and lean body mass
during testosterone administration in men with acquired hypogonadism. J Clin Endocrinol Metab 1996;81(12):4358–65.
56. Androgen and Metabolic
Control
Androgen deprivation treatment of men with prostate
cancer increases fat mass, reduces insulin sensitivity
and impairs lipid profiles increasing cardiovascular risk
or considerably worsens the metabolic control of men
with diabetes mellitus
Lower endogenous androgens predict central adiposity
in men, and androgen level is inversely correlated with
levels of blood pressure, fasting plasma glucose,
triglycerides and BMI, but positively correlated with
HDL
Rosmond R, Wallerius S, Wanger P, Martin L, Holm G, Bjorntorp P. A 5-year follow-up study of disease incidence in men with an
abnormal hormone pattern. J Intern Med 2003;254(4):386–90.
Zmuda JM, Cauley JA, Kriska A, Glynn NW, Gutai JP, Kuller LH. Longitudinal relation between endogenous testosterone and
cardiovascular disease risk factors in middleaged men. A 13-year follow-up of former Multiple Risk Factor Intervention Trial participants.
Am J Epidemiol 1997;146(8):609–17.
57. Hormonal Fat Regulation
The activity of lipoprotein lipase, the enzyme responsible for the
accumulation of triglycerides in the fat cell, is higher in the
gluteo-femoral region than in the abdominal area.
Conversely, lipolysis is regulated by hormone-sensitive lipase,
which is regulated by several hormones and by the sympathetic
nervous system.
The visceral fat depot constitutes a quickly available source of
calories and energy. By its close anatomical proximity to the liver
it delivers fatty acids through the portal system. The latter may
have served a useful function in evolution, suiting the needs of
men for quick physical action and employment in manual labor.
Louis Gooren. Obesity: new aspects. Journal of Men's Health. Volume 5, Issue 3, September 2008, Pages 249-256
58. Stress and Obesity
The pattern of fat distribution in the metabolic syndrome
shows similarities with the clinical manifestation of
increased blood cortisol
Elevated glucocorticoid exposure might be a factor in the
pathogenesis of obesity in general and in
abdominal/visceral obesity in particular
The hormonal correlates of stress (an overactivity of the
hypothalamo–pituitary–adrenal-axis) being associated
with a low secretion of sex steroids and growth hormone.
Deficiencies of the latter two hormones are characterized
by an accumulation of visceral fat.
Louis Gooren. Obesity: new aspects. Journal of Men's Health. Volume 5, Issue 3, September 2008, Pages 249-256
59. 12 weeks
Control Diet
long-acting
GnRH analog
High Fat Diet
(0.5% cholesterol + 4% peanut oil)
High Fat Diet + T
(pharmacological dose)
Filippi S, Vignozzi L, Morelli A, Chavalmane AK, Sarchielli E, Fibbi B, Saad F, Sandner P, Ruggiano P, Vannelli GB,
Mannucci E, Maggi M. Testosterone partially ameliorates metabolic profile and erectile responsiveness to PDE5 inhibitors in
an animal model of male metabolic syndrome. J Sex Med 2009; 6 (12): 3274-88.
60. Testosterone Ameliorates Metabolic
Profile in an Animal Model of Metabolic
Syndrome
HFD rabbits showed all the features of MetS.
HFD induced hypogonadotropic hypogonadism is
characterized by a reduction of plasma T, FSH, LH
levels, testis and and seminal vesicles weight.
Such changes were similar to that induced by
GnRH analog administration.
Filippi S, Vignozzi L, Morelli A, Chavalmane AK, Sarchielli E, Fibbi B, Saad F, Sandner P, Ruggiano P, Vannelli GB,
Mannucci E, Maggi M. Testosterone partially ameliorates metabolic profile and erectile responsiveness to PDE5 inhibitors in
an animal model of male metabolic syndrome. J Sex Med 2009; 6 (12): 3274-88.
61. Testosterone Ameliorates Erectile
Responsiveness to PDE5 Inhibitors in an
Animal Model of Metabolic Syndrome
HFD also induced penile alterations,
- Reduction of cavernosal smooth muscle relaxation
induced by electrical field stimulation
- Reduced response to Sildenafil.
T administration prevented almost all penile alterations
observed in HFD rabbits.
T treatment dramatically reduced visceral obesity.
Filippi S, Vignozzi L, Morelli A, Chavalmane AK, Sarchielli E, Fibbi B, Saad F, Sandner P, Ruggiano P, Vannelli GB,
Mannucci E, Maggi M. Testosterone partially ameliorates metabolic profile and erectile responsiveness to PDE5 inhibitors in
an animal model of male metabolic syndrome. J Sex Med 2009; 6 (12): 3274-88.
62. EFS-induced CC
Relaxation (%)
Testosterone Ameliorates Erectile
Responsiveness to PDE5 Inhibitors in an
Animal Model of Metabolic Syndrome
Sildenafil (nM)
Filippi S, Vignozzi L, Morelli A, Chavalmane AK, Sarchielli E, Fibbi B, Saad F, Sandner P, Ruggiano P, Vannelli GB,
Mannucci E, Maggi M. Testosterone partially ameliorates metabolic profile and erectile responsiveness to PDE5 inhibitors in
an animal model of male metabolic syndrome. J Sex Med 2009; 6 (12): 3274-88.
64. Response to sildenafil in ED
Patients with Metabolic Syndrome
Suetomi et al, evaluated the response to sildenafil
in ED patients with metabolic syndrome
The study included 133 ED patients
25 patients met the criteria for MetS using the IDF criteria
for Japanese men (cut-point for WC = 90 cm)
Patients received 50 mg sildenafil on demand
Response was evaluated after usage of 8 doses or more,
using IIEF score
Suetomi et al, 2008. Negative impact of metabolic syndrome on the responsiveness to sildenafil in Japanese men. J Sex
Med 2008;5:1443–1450
65. Response to sildenafil in
Metabolic Syndrome Patients
Metabolic syndrome1
Other ED patients2
1. Suetomi et al., 2008. Negative impact of metabolic syndrome on the responsiveness to sildenafil in Japanese
men. J Sex Med 2008;5:1443–1450
2. Kobayashi et al. 2006. Outcome analysis of sildenafil citrate for erectile dysfunction of Japanese patients. Int J
Impot Res 2006;18:302–5
66. Response rate
Response rate of sildenafil
according to MetS components
*
*
MetS component
Suetomi et al., 2008. Negative impact of metabolic syndrome on the responsiveness to sildenafil in Japanese men. J Sex
Med 2008;5:1443–1450
67. IIEF-EF score
IIEF Score Before and After
Sildenafil Treatment
Suetomi et al., 2008. Negative impact of metabolic syndrome on the responsiveness to sildenafil in Japanese men. J Sex
Med 2008;5:1443–1450
68. Response rate to 50 mg
Response Rate of Sildenafil
IDF for Japanese men
Suetomi T, Kawai K, Hinotsu S, Joraku A, Oikawa T, Sekido N, Miyanaga N, Shimazui T, and Akaza H. Negative impact of
metabolic syndrome on the responsiveness to sildenafil in Japanese men. J Sex Med 2008;5:1443–1450
69. The Odds Ratios for Sildenafil
Non-response
◆
Age > 60
◆
Severe ED
◆
Pelvic surgery
3.3
◆
Metabolic syndrome
0.1
1
10
100
The Odds Ratios for Sildenafil Non-response
Suetomi et al., 2008. Negative impact of metabolic syndrome on the responsiveness to sildenafil in Japanese men. J Sex
Med 2008;5:1443–1450
70. Vardenafil for the Treatment of ED
in Men with Metabolic Syndrome
A 12 weeks double-blind, randomized, placebocontrolled study including 145 men with ED and
metabolic syndrome.
Two groups (Vardenafil N=75; placebo, N=70).
Vardenafil was administered at a starting dose of
10 mg, which could be titrated to 5 mg or 20 mg
after 4 weeks, depending on efficacy and
tolerability.
Schneider et al. Efficacy and safety of vardenafil for the treatment of erectile dysfunction in men with metabolic syndrome:
results of a randomized, placebo-controlled trial. J Sex Med DOI: 10.1111/j.1743-6109.2011.02383.x
71. IIEF-EF scores
Vardenafil for the Treatment of
ED in Men with Metabolic
Syndrome
n=75
n=70
Schneider et al. Efficacy and safety of vardenafil for the treatment of erectile dysfunction in men with metabolic syndrome:
results of a randomized, placebo-controlled trial. J Sex Med DOI: 10.1111/j.1743-6109.2011.02383.x
72. (successful penetration)
SEP2
Vardenafil for the Treatment of ED in
Men with Metabolic Syndrome
Schneider et al. Efficacy and safety of vardenafil for the treatment of erectile dysfunction in men with metabolic syndrome:
results of a randomized, placebo-controlled trial. J Sex Med DOI: 10.1111/j.1743-6109.2011.02383.x
73. (successful Intercourae)
SEP3
Vardenafil for the Treatment of ED in
Men with Metabolic Syndrome
Schneider et al. Efficacy and safety of vardenafil for the treatment of erectile dysfunction in men with metabolic syndrome:
results of a randomized, placebo-controlled trial. J Sex Med DOI: 10.1111/j.1743-6109.2011.02383.x
74. Management of metabolic
syndrome
Management is aimed primarily at reducing longer-term
risk of cardiovascular diseases and diabetes.
Current guidelines recommend initial focus on intensive
therapeutic lifestyle interventions (such as increased
physical activity, dietary modification and modest weight
reduction) that address many of the metabolic risk
factors including insulin resistance.
Cardiovascular risk should also be assessed to guide
clinical management of individual risk factors. If
necessary, pharmacological agents should be used to
achieve recommended therapeutic targets
Eckel RH, Grundy SM, Zimmet PZ. The metabolic syndrome. Lancet 2005; 365: 1415-1428.
75. Onset of effects of testosterone and
time span until maximum effects
Sexual interest and desire
Sexual thoughts and fantasy
Erectile
function
Morning erections
Satisfaction with sex life
Number of
erections / week
Sexual
activity/ejaculations
Saad F et al. Eur J Endocrinol 2011;165:675-685
77. Conclusions
About 25% of men world wide have metabolic
syndrome. The prevalence is higher in the Middle
East
Metabolic syndrome impairs erectile function
through impaired endothelial function and
increased incidence of hypogonadism.
Metabolic Syndrome has a negative impact on the
efficacy of PDE5 inhibitors.
Metabolic syndrome impairs all domains of female
sexual function
78. Conclusions
Men with erectile dysfunction should be thoroughly
investigated for metabolic syndrome components
Early detection of metabolic syndrome in patients
with ED may be a gateway to the reduction of
cardiovascular diseases and diabetes in younger
men with increased risk, who present for treatment
of ED alone.
Editor's Notes
Hanefeld and Leonhardt in 1981 were the first to coin the term “Metabolic Syndrome”
Since that report was published in the German language and behind the “iron curtain” it remained unnoticed by many scientists and clinicians until later
WHO Criteria #1 plus 2 of the other 4
NCEP ≥ 3 of 5 criteria
Criteria #2 plus 2 of the other 4
The definitions of MetS have provided clear criteria by which subjects can be evaluated by physicians, however, not all clinical studies have used the same definition, making comparisons among such studies difficult
Diabetes FBS > 126, hypertension Sys BP > 140/90
Age-Specific Prevalence of the Metabolic Syndrome Among 8814 US Adults Aged at Least 20 Years, by Sex, National Health and Nutrition Examination Survey III, 1988-1994
6.7% among participants aged 20 through 29 years to 43.5% and 42.0% for participants aged 60
through 69 years and aged at least 70 years
100 Men with metabolic syndrome were recruited among those attending the outpatient department for metabolic diseases of the teaching hospital in Italy
Men with the metabolic syndrome were matched with men of the control group for age and BMI.
Erectile dysfunction prevalence (IIEF <21) increased as the number of components of the metabolic
syndrome increased
A total of 268 patients were included in this study. 89 patients (33%) constituted the metabolic syndrome by NCEP chriteria
393 male patients aged 40 to 70 years, who were admitted to
the urology clinics of four different institutions. Of the 393 patients, 157 (39.9%) had MS
Bansal et al determined the incidence of metabolic syndrome in 154 men with organic ED
Metabolic syndrome was present in 43% of ED population as opposed to 24% in a matched patient
population
Sexual Health Inventory for Men
Sexual function was assessed using the Female Sexual Function Index (FSFI), a recognized 19-item questionnaire. The maximum score for this scale is 36. Sexual function was considered good if the score was 30 or above, intermediate if between 23 and 29, and poor if below 23.
Female Sexual Function Index is a validated 19-item self-report measure of female sexual function. The 19 items are assigned to six separate domains of female sexual function. Four domains are related to the four major categories of sexual dysfunction: desire disorder, arousal disorder, orgasmic disorder, and sexual pain disorder. The fifth domain assesses the quality of vaginal lubrication, whether the sixth domain is related to global sexual and relationship satisfaction: it is viewed as the 'quality of life' domain of the scale. Each domain is scored on a scale of zero or 1-6, with higher score indicating better function. The full FSFI scale score, which could be 36 at the highest, was obtained by adding the six domain scores. We considered the functional results to be good when the FSFI score was 30 or more, intermediate between 23 and 29, and poor below 23.
A total of 268 patients were included in this study. 89 patients (33%) constituted the metabolic syndrome by NCEP chriteria
100 Men with metabolic syndrome 50 controls
Men with the metabolic syndrome were matched with men of the control group for age and BMI.
Endothelial function was assessed with the L-arginine test, a score in which the blood pressure and platelet aggregation responses to L-Arginine (3 g i.v.) were summed. This gives a score ranging from 0 points, indicating maximal impairment of endothelial function, to 10 points, indicating normal function of the endothelium
100 Men with metabolic syndrome 50 controls
Men with the metabolic syndrome were matched with men of the control group for age and BMI.
Endothelial function was assessed with the L-arginine test, a score in which the blood pressure and platelet aggregation responses to L-Arginine (3 g i.v.) were summed. This gives a score ranging from 0 points, indicating maximal impairment of endothelial function, to 10 points, indicating normal function of the endothelium
100 Men with metabolic syndrome 50 controls
Men with the metabolic syndrome were matched with men of the control group for age and BMI.
Endothelial function was assessed with the L-arginine test, a score in which the blood pressure and platelet aggregation responses to L-Arginine (3 g i.v.) were summed. This gives a score ranging from 0 points, indicating maximal impairment of endothelial function, to 10 points, indicating normal function of the endothelium
A consecutive series of 1,134 (mean age 52.1 13 years) male patients with sexual dysfunction was
studied
Incidence of metabolic syndrome 29%
total testosterone < 10.4 nmol/L,
Corona et al studied 803 patients with sexual dysfunction. 236 patients (29.4%) diagnosed as having a MS by NCEP
Relationship between total testosterone (TT) and the number of MS components
Corona et al studied 803 patients with sexual dysfunction. 236 patients (29.4%) diagnosed as having a MS by NCEP
Relative risk for hypogonadism (TT < 8 nM) accordingly with the number of MS components
Corona et al studied 803 patients with sexual dysfunction. 236 patients (29.4%) diagnosed as having a MS by NCEP. Odds ratio (95% CI) for hypogonadism (TT < 8 nM) as detected by logistic regression analysis, considering MS components as putative predictors
Increasing abdominal obesity leads to increased activity of the enzyme aromatase, present in adipose tissue, which converts testosterone to oestrogen. The resulting low testosterone level increases lipoprotein lipase enzyme activity and triglyceride uptake leading to increased obesity and insulin resistance. This in turn causes further androgen deficiency and visceral fat deposition. Estradiol inhibits gonadotrophin release from the pituitary. Furthermore, testosterone levels are also lowered as a result of leptin resistance at the hypothalamic-pituitary level and the inhibitory effect of leptin on the testicular axis. Pro-inflammatory adipocytokines such as tumor necrosis a (TNF-a) and interleukin 6 (IL-6) could also potentially inhibit the pituitary axis resulting in low testosterone levels. Increased cortisol secretion affecting T production via the hypothalamic pituitary access
Vascular endothelial growth factor (VEGF)
Vascular endothelial growth factor (VEGF)
Male New Zealand White rabbits. After 1 week of standard rabbit diet, animals were randomly assigned to control or treatment group. The control group continued to receive a standard diet (control) while the treatment group was fed HFD, constituted by 0.5% cholesterol and 4% peanut oil (HFD rabbit) for 12 weeks. A first subset of HFD rabbits was supplemented with a pharmacological dose of T (30 mg/kg weekly i.m.) A second subset of control rabbits was treated for the last 8 weeks with the long-acting GnRH analog, in order to induce a hypogonadotropic hypogonadism
only 50 mg available in Japan
Questions 3 (Q3, ability to achieve an erection) and 4 (Q4, ability to maintain an erection) of IIEF
50 mg dose
8 doses
asian IDF
Q3 and Q4 of IIEF score ≥4
a logistic regression analysis considering independent risk factors for nonresponse to sildenafil. The adjusted odds ratio for the risk was 7.47 for severe ED, 8.83 for presence of history of pelvic surgery, and 3.30 for presence of MS. Interestingly, this study showed that MS was a more significant risk factor than age