Earwood - Metabolic Syndrome

8/13/2019 Earwood - Metabolic Syndrome

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Metabolic Syndrome

MAJ(P) J. Scott Earwood

Metabolic Syndrome

MAJ(P) J. Scott Earwood


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Goals

Define Metabolic Syndrome

Emphasize that visceral obesity is an

indicator of the syndrome and an

independent marker for CVD Review current and some potential future

treatment options


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An estimated 47 million people have

metabolic syndrome in the U.S.

NHANES III 1988-94, JAMA 2002


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ATP III Clinical Identification of the

Metabolic Syndrome

Waist circumference:

Men>102 cm (>40 in) Women>88 cm (>35 in)

Triglycerides >150 mg/dL

HDL cholesterol: Men100mg/dl increases risk for Metabolic Syndrome


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International Diabetes Federation

(IDF) Definition

Modified ATPIII definition

Fasting Glucose > 100mg/dl

Adjusted waist circumference based on

ethnicity (i.e. asians with lower waistcircumference threshold than pacific islanders)


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Lahey Clinic Study--50-60% of Pts


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Obesity is a Cardiovascular Risk

Factor:

Linear Increase in Risk for Cardiovascular

Disease with increase in BMI from 25 to 35

(unrelated to HDL, and LDL)


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Specifically, Visceral Obesity

Elevated waist circumference

TGWaist circumference)


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Look at your patients shape
http://images.google.com/imgres?imgurl=http://www.actden.com/grap_den/clipart/images/pear.jpg&imgrefurl=http://www.actden.com/grap_den/clipart/pear.htm&h=338&w=269&sz=26&tbnid=OENUH1ppgX60SM:&tbnh=119&tbnw=95&prev=/images%3Fq%3Dpear%2Bpicture&start=3&sa=X&oi=images&ct=image&cd=3http://metabolicsyndrome.about.com/od/exercise/p/MetabolicRate.htm


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Other Indicators of Metabolic

Syndrome and CV Risk

CRP

Borderline LDL


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EBM Recommendations

Any person at high risk or moderately high

risk who has lifestyle-related risk factors (e.g.,

obesity, physical inactivity, elevated

triglyceride, low HDL-C, or metabolicsyndrome) is a candidate for therapeutic

lifestyle changes to modify these risk factors

regardless of LDL-C level.


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EBM Recommendations (cont.)

There is some evidence that insulin

sensitizing agents such as metformin are

effective in treating features of metabolic

syndrome.


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Current Treatments

Weight reduction

TLC: Diet and Exercise

Lower BP goals

Lower LDL goals

Statins

Metformin

Aspirin therapy


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Possible New Markers

Adiponectin (cytokine released from

peripheral adipose tissue) low levels

associated with increased risk for MI


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Possible New Therapies

Endocannabinoid system

Phospholipid derivatives over-produced in

obese patients

CB1 receptor


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Possible New Therapies (Cont.)

CB1 receptorsanimal studies

Hypothalamusregulates energy metabolism

Liverlipogenesis

Adipose tissues Lipogenesis

Fat accumulation

Inhibition of adiponectin


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Possible New Therapies (Cont.)

RIO-LIPID trial (2005 NEJM)

Placebo group weight

2kg

4kg

Abdominal circumference

2.5cm

4.5cm

HDL-C

15%

CB1 receptor blocker weight

8kg

Abdominal circumference

9cm

HDL-C

25%

CRP 27%

Adiponectin 46%


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Summary

The definition for metabolic syndrome is

straight forward

We see these patients every day in our

practices Weight reduction is the key to preventing

CVD

There are some new exciting treatments onthe horizon


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Question?


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References

Third report of the National Cholesterol EducationProgram (NCEP) Expert Panel on Detection,Evaluation, and Treatment of High Blood Cholesterolin Adults (Adult Treatment Panel III). (2)Implicationsof recent clinical trials for the National Cholesterol

Education Program Adult Treatment Panel IIIGuidelines.

International Diabetes Federation

Insulin-sensitising drugs, The Cochrane Database ofSystematic Reviews Date of last Substantial Update:

December 31. 2002 Effects of Rimonabant on Metabolic Risk Factors in

Overweight Patients with Dyslipidemia, NEJM. Nov2005

Earwood - Metabolic Syndrome

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