ebm- 7.metabolik syndrome i

8/19/2019 EBM- 7.Metabolik Syndrome i

1/32

METABOLIC

SYNDROME


2/32

Other Names Used:

• Syndrome X

• Cardiometabolic Syndrome

• Cardiovascular Dysmetabolic Syndrome

• Insulin-Resistance Syndrome

• Metabolic Syndrome

• eer elly Syndrome

• Reaven!s Syndrome

• etc"


3/32

The concept has existed for more than 8 !earsThe concept has existed for more than 8 !ears


4/32

De#inisi Insulin resistance:

• Im$aired res$onse to the $hysiolo%ical e##ects o#

insulin &includin% on %lucosa' li$id and $rotein

metabolisme( and the e##ect on endothelial

#unction"

• )lucose can no lon%er be absorbed by the cells

but remains in the blood' tri%%erin% the need #ormore and more insulin &hyperinsulinaemia("

*D*" Diab Care +,


5/32

The Metabolic Syndrome (“DeadlyQuartet”)

.! * cluster o# ris/ #actors #or diabetes and

cardiovascular disease!! consistin% o#:

• Central &abdominal( obesity

• Diabetes' I)0 and I1)

• 2y$ertension

• Dysli$idaemia


6/32

3harmacodynamics o# insulin

4 Affects all major metabolic pathways

carbohydrate, fat, protein

* Major target tissues are liver, adipose, and skeletal muscle

* Decreases hepatic glucose production

decreases gluconeogenesis, glycogenolysis, ketogenesis,(also glycogen synthesis(


7/32

She$herd 3R et al" )lucose trans$orters and insulin action" N56M' 6uly 77' +,,,

Glucose transporters and insulinaction


8/32

Insulin ResistanceInsulin Resistanceproblemproblem::

Receptor:

Quantity / function

Post-receptor (mostly):

Translocation of GLUT:

IRS (insulin receptor substance) / kinase

S ynthesis of GLUT


9/32

Insulin resistance 8 reduced

res$onse to circulatin% insulin

Insulin

resistance

Glucose output ↓ Glucose uptake ↓ Glucose uptake

Hyperlycemia

!i"er Muscle #diposetissue

I$


10/32


11/32

Insulin Resistance: *ssociated

Conditions


12/32

0he Metabolic Syndrome Is

* Metabolic 0ime omb


13/32

Prevalence

• Affects as many as one in four American adults (!"#

• $or adults over the age of %&, more than %&"

• increased '" over the past decade)

• ates differ among races and genders)

National Health and NutritionExamination Survey III, 19!199"#


14/32

Risk Factors

Age 0he $revalence o# metabolic syndrome increases 9ith a%e' a##ectin%less than +; o# $eo$le in their 7s and &MI( %reater than 7? increases your ris/ o#metabolic syndrome and abdominal obesity increase the ris/ o# MS" *bdominal obesity re#ers to havin% an a$$le sha$e rather than a $ear"

History of

diabetes

2avin% a #amily history o# ty$e 7 diabetes or diabetes durin% $re%nancy

&%estational diabetes( increases the ris/ #or develo$in% metabolicsyndrome"

Otherdiseases

* dia%nosis o# hy$ertension' cardiovascular disease &C@D( or$olycystic ovary syndrome &a hormonal disorder in 9hich a 9oman!sbody $roduces an e>cess o# male hormones( also increases the ris/ #ormetabolic syndrome"

Apple Pear


15/32

+linical +auses of he Metabolic

-yndrome

• .verweight/obesity

• 0hysical inactivity

• 1enetics

NC53 *03 III" Circulation. 77A+=:B+


16/32

%#&S' The Metabolic Syndrome%#&S' The Metabolic Syndromea netork o* atheroenic *actorsa netork o* atheroenic *actors

#therosclerosis

Mc+arlane S, et al - J Clin Endocrinol Metab .//01 234056402-

Genetic *actors'n"ironmental*actors

Insulin $esistance

Hyperlycemia7IGT

8isceral obesity

Dyslipidemia

Hypertension7Microalbuminuria

the deadly uartet


17/32

Insulin $esistance Syndrome

Genetic

In*luences

Insulin

$esistance

'n"ironmental

In*luences

Hyperlipidemia

Glucose

Intolerance

Increase

Trilycerides

Decreased

HD!

%holesterol

Small Dense

!D!

Increased

9lood

:ressure:#I;0

%oronary Heart

Disease


18/32

The Metabolic Syndrome Genes <

'n"ironment Interactin

MetabolicMetabolic

SyndromeSyndrome

#dult li*e

• Sedentary li*estyle

• Dietary *actors

Genes

'arly !i*e

• !o birth eiht

• :oor nutrition

%#$DI=8#S%&!#$%#$DI=8#S%&!#$

DIS'#S'DIS'#S'


19/32

he Metabolic -yndrome2

Current erspecti!e

*da$ted #rom Reaven )" Dru%s" +,,,A? &su$$l(:+,-7

9ody Si>e9ody Si>e 9MI9MI

%entral #diposity%entral #diposity

)lucose)lucose

MetabolismMetabolismUric *cidUric *cid

MetabolismMetabolismDysli$idemiaDysli$idemia 2emodynamic

Novel Ris/1actors

%=$=?#$@ H'#$T DIS'#S'%=$=?#$@ H'#$T DIS'#S'

Insulin $esistanceInsulin $esistance

HyperinsulinemiaHyperinsulinemiaAA

0)0)

33 li$emia33 li$emia 2D-C2D-C 32*32*Small' dense DSmall' dense D

±±

GlucoseGlucoseintoleranceintolerance

Uric acidUric acid

UrinaryUrinaryuricuricacid clearanceacid clearance

SNS activitySNS activity

Na retentionNa retention2y$ertension2y$ertension

CR3CR3

3*I-+3*I-+ 1ibrino%en1ibrino%en


20/32

Si$ns and Symptoms


21/32

Criteria #or dia%nosis:

Eorld 2ealth Or%aniFation

International Diabetes Federation (IDF)

5uro$ean *ssociation #or the Study o#

Diabetes &5*SD(

National Cholesterol 5ducation 3roGect' *dult 0reatment 3anel &NC53-*03 III(

Others


22/32

HHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHH

he Metabolic -yndrome 0roposed definitions

BH=Main criteria

3nsulin resistance

"RDM / 31 / 3$1

.ther components

#4lood pressure5%&/6&

#Dyslipidemia

7#+entral obesity

%#Microalbuminura

(t#o or $ore)

#T:III#Abdominal

obesity

#8igh triglycerides7#9ow 8D9

cholesterol

%#4lood pressure

57&/:!!#8igh fasting

glucose

(three or $ore)

'GI$Main criteria

3nsulin resistance

.ther components

#8yperglycemia# 4lood pressure

5%&/6&

7#Dyslipidemia

%#+entral obesity

(t#o or $ore)

I t ti l Di b t + d ti (ID+)


23/32

International Diabetes +ederation (ID+)

%onsensus De*inition .//C

+entral .besity

"aist circ#mference $ ethnicit! specific% $ for E#ropids& Ma'e ( )* cm +) Cm

,ema'e ( 8 cm +8 cm-

p'#s an! t.o of the fo''o.in/&

Raised tri/'!cerides ( 01 m/2dL +034 mmo'2L-

or specific treatment for this lipid abnormality

Red#ced 5DLcho'estero'

6 * m/2dL +037 mmo'2L- in ma'es

6 1 m/2dL +03) mmo'2L- in fema'es

or specific treatment for this lipid abnormality

Raised 9'ood press#re S!sto'ic & ( 07 mm5/ or

Diasto'ic& ( 81 mm5/ or

Treatment of previously diagnosed hypertension

Raised fastin/ p'asma/'#cose

,astin/ p'asma /'#cose ( 0 m/2dL +13: mmo'2L- or

;re


24/32

T'ST I?S&!I? $'SIST#?


25/32

TG

IFG & Diabetes

AbdominalObesity

BP

HDL

Apo BLittle LDL

PAI-1

Adipo-nectin

InsulinResistance

!RP

HO"A# eu$lycemic clamp# %astin$ insulin etc

"icoalb

Tests $ecommended *or $esearch May 9e #dded

To De*inition !ater

OGTT


26/32

MA;A1


27/32

Dru% 0reatment o#

0he Metabolic Syndrome

• *chieve D-C tar%ets

• Correct athero%enic dysli$idemia• Non 2D-C tar%et %oal is second $riority

• Consider 2D-C raisin%

• Control diabetes mellitus i# $resent



28/32

Dru% 0hera$y o# 0he Metabolic Syndrome

• Decrease small' dense D $articles 8 Statins

8 Nicotinic acid &niacin(

8 1ibrates

&statins may be more e##ective in reducin% total number o# D $articles(

• Decrease tri%lycerides 8 1ibrates

8 Ome%a-B #atty acids

8 Nicotinic acid &niacin(

8 Statins

• Increase 2D-C 8 Nicotinic acid &niacin(

8 1ibrates' es$ecially i# hy$ertri%lyceridemia is $resent



29/32

Summary o# 0he Metabolic Syndrome

• Dia%nosis indicates a hi%h-ris/ $atient

beyond that classically de#ined by ris/ #actor

assessment

• *chieve D-C tar%et %oals

• Control athero%enic dysli$idemia

• Eei%ht loss and increased $hysical activitydeserve a hi%h $riority



30/32

Insulin $esistance ; Hidden Daners

Type 2 Diabetes

•Hyperinsulinemia•IGT

•Dyslipidemia

•Hypertension•Coagulation

abnormality

IGT = impaired glucose tolerance


31/32


32/32

6oslin A Diabetes Mellitus +

ebm- 7.metabolik syndrome i

Documents