Timothy A. Denton, M.D., F.A.C.C. High Desert Heart Institute Victorville, CA
Obesity, Metabolic Syndrome and Diabetes in Hispanics: implications on Cardiovascular Disease 2011...
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Transcript of Obesity, Metabolic Syndrome and Diabetes in Hispanics: implications on Cardiovascular Disease 2011...
Obesity , Metabolic Obesity , Metabolic Syndrome and Diabetes Syndrome and Diabetes
in Hispanics: implications in Hispanics: implications on Cardiovascular on Cardiovascular
Disease 2011Disease 2011
Obesity , Metabolic Obesity , Metabolic Syndrome and Diabetes Syndrome and Diabetes
in Hispanics: implications in Hispanics: implications on Cardiovascular on Cardiovascular
Disease 2011Disease 2011Eduardo de Marchena M.D., F.A.C.C., F.A.C.P.Eduardo de Marchena M.D., F.A.C.C., F.A.C.P.
Professor of Medicine & SurgeryProfessor of Medicine & SurgeryAssociate Dean for International Medicine & Associate Dean for International Medicine &
Director International Medicine InstituteDirector International Medicine InstituteDirector of Cardiovascular Center Director of Cardiovascular Center
University of Miami Miller School of MedicineUniversity of Miami Miller School of Medicine
Eduardo de Marchena M.D., F.A.C.C., F.A.C.P.Eduardo de Marchena M.D., F.A.C.C., F.A.C.P.Professor of Medicine & SurgeryProfessor of Medicine & Surgery
Associate Dean for International Medicine & Associate Dean for International Medicine & Director International Medicine InstituteDirector International Medicine Institute
Director of Cardiovascular Center Director of Cardiovascular Center University of Miami Miller School of MedicineUniversity of Miami Miller School of Medicine
Obesity Trends* Among U.S. AdultsBRFSS, 1985
Obesity Trends* Among U.S. AdultsBRFSS, 1985
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14%
Obesity Trends* Among U.S. AdultsBRFSS, 1986
Obesity Trends* Among U.S. AdultsBRFSS, 1986
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14%
Obesity Trends* Among U.S. AdultsBRFSS, 1987
Obesity Trends* Among U.S. AdultsBRFSS, 1987
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14%
Obesity Trends* Among U.S. AdultsBRFSS, 1988
Obesity Trends* Among U.S. AdultsBRFSS, 1988
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14%
Obesity Trends* Among U.S. AdultsBRFSS, 1989
Obesity Trends* Among U.S. AdultsBRFSS, 1989
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14%
Obesity Trends* Among U.S. AdultsBRFSS, 1990
Obesity Trends* Among U.S. AdultsBRFSS, 1990
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14%
Obesity Trends* Among U.S. AdultsBRFSS, 1991
Obesity Trends* Among U.S. AdultsBRFSS, 1991
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19%
Obesity Trends* Among U.S. AdultsBRFSS, 1992
Obesity Trends* Among U.S. AdultsBRFSS, 1992
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19%
Obesity Trends* Among U.S. AdultsBRFSS, 1993
Obesity Trends* Among U.S. AdultsBRFSS, 1993
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19%
Obesity Trends* Among U.S. AdultsBRFSS, 1994
Obesity Trends* Among U.S. AdultsBRFSS, 1994
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19%
Obesity Trends* Among U.S. Adults BRFSS, 1995
Obesity Trends* Among U.S. Adults BRFSS, 1995
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19%
Obesity Trends* Among U.S. AdultsBRFSS, 1996
Obesity Trends* Among U.S. AdultsBRFSS, 1996
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19%
Obesity Trends* Among U.S. AdultsBRFSS, 1997
Obesity Trends* Among U.S. AdultsBRFSS, 1997
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% ≥20%
Obesity Trends* Among U.S. AdultsBRFSS, 1998
Obesity Trends* Among U.S. AdultsBRFSS, 1998
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% ≥20%
Obesity Trends* Among U.S. AdultsBRFSS, 1999
Obesity Trends* Among U.S. AdultsBRFSS, 1999
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% ≥20%
Obesity Trends* Among U.S. AdultsBRFSS, 2000
Obesity Trends* Among U.S. AdultsBRFSS, 2000
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% ≥20%
Obesity Trends* Among U.S. AdultsBRFSS, 2001
Obesity Trends* Among U.S. AdultsBRFSS, 2001
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% ≥25%
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
Obesity Trends* Among U.S. AdultsBRFSS, 2002
No Data <10% 10%–14% 15%–19% 20%–24% ≥25%
Obesity Trends* Among U.S. AdultsBRFSS, 2003
Obesity Trends* Among U.S. AdultsBRFSS, 2003
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% ≥25%
Obesity Trends* Among U.S. AdultsBRFSS, 2004
Obesity Trends* Among U.S. AdultsBRFSS, 2004
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% ≥25%
Obesity Trends* Among U.S. AdultsBRFSS, 2005
Obesity Trends* Among U.S. AdultsBRFSS, 2005
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
Obesity Trends* Among U.S. AdultsBRFSS, 2006
Obesity Trends* Among U.S. AdultsBRFSS, 2006
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
Obesity Trends* Among U.S. AdultsBRFSS, 2007
Obesity Trends* Among U.S. AdultsBRFSS, 2007
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14%No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% 15%–19% 20%–24% 25%–29% ≥30%
Obesity Trends* Among U.S. AdultsBRFSS, 2008
Obesity Trends* Among U.S. AdultsBRFSS, 2008
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14%No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% 15%–19% 20%–24% 25%–29% ≥30%
Obesity Trends* Among U.S. AdultsBRFSS, 2009
Obesity Trends* Among U.S. AdultsBRFSS, 2009
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14%No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% 15%–19% 20%–24% 25%–29% ≥30%
““Globesity” Globesity” ““Globesity” Globesity”
Colombia and BrazilColombia and Brazil40% women in 200140% women in 2001
Prevalence of Obesity Prevalence of Obesity in Malesin Males
Prevalence of Obesity Prevalence of Obesity in Malesin Males
Prevalence of Obesity Prevalence of Obesity in Femalesin Females
Prevalence of Obesity Prevalence of Obesity in Femalesin Females
““Globesity”Globesity”““Globesity”Globesity”
Alarming trend for Alarming trend for Obesity in ChildrenObesity in ChildrenAlarming trend for Alarming trend for Obesity in ChildrenObesity in Children
Evolution of ManEvolution of ManEvolution of ManEvolution of Man
2.5 million years 50 years
DietDiet
ExerciseExercise
2050 New Concept of Ideal Body
Type
2050 New Concept of Ideal Body
Type
0
1
2
3
4
5
6
7
1958 61 64 67 70 73 76 79 82 85 88 91 94 97 00 03 06
Year
Per
cen
t w
ith
Dia
bet
es
0
2
4
6
8
10
12
14
16
18
20
Nu
mb
er w
ith
Dia
bet
es (
Mil
lio
ns)Percent with Diabetes
Number with Diabetes
Number and Percentage of U.S. Population with Diagnosed Diabetes, 1958-2008
CDC’s Division of Diabetes Translation. National Diabetes Surveillance System available at http://www.cdc.gov/diabetes/statistics
Source: International Diabetes Federation (IDF) (2009), “Diabetes Atlas, 4th edition”.
Note: The data are age-standardised to the World Standard Population.
However, the prevalence of chronic diseases such as diabetes
is rising, due to population aging but also to changes in lifestylePrevalence estimates of diabetes, adults aged 20-79 years, 2010
Age-adjusted Percentage of U.S. Adults Who Age-adjusted Percentage of U.S. Adults Who Were Obese or Who Had Diagnosed Diabetes Were Obese or Who Had Diagnosed Diabetes
Obesity (BMI ≥30 kg/mObesity (BMI ≥30 kg/m22))
DiabetesDiabetes
19941994
19941994
20002000
20002000
No Data <14.0% 14.0-17.9% 18.0-21.9% 22.0-25.9% No Data <14.0% 14.0-17.9% 18.0-21.9% 22.0-25.9% >>26.0%26.0%
No Data <4.5% 4.5-5.9% 6.0-7.4% 7.5-8.9% No Data <4.5% 4.5-5.9% 6.0-7.4% 7.5-8.9% >>9.0%9.0%
CDC’s Division of Diabetes Translation. National Diabetes Surveillance System CDC’s Division of Diabetes Translation. National Diabetes Surveillance System available at http://www.cdc.gov/diabetes/statisticsavailable at http://www.cdc.gov/diabetes/statistics
20082008
20082008
(*BMI 30)
Hispanic
State-specific Prevalence of Obesity* State-specific Prevalence of Obesity* Among U.S. Adults, by Race/Ethnicity, Among U.S. Adults, by Race/Ethnicity,
2006-20082006-2008White non-Hispanic
Black non-Hispanic
Prevalence of Physician Diagnosed Type 2 diabetes in Adults
age 20+ by Race/Ethnicity, and Years of Education (NHANES: 2003-2006). Source: NCHS and NHLBI. NH – non-
Hispanic.
9.2
13.4 12.8
6.2
9.6
5.8
11.013.0
15.3
02468
1012141618
NH Whites NH Blacks Mexican Americans
Per
cen
t o
f P
op
ula
tio
n
Less than high school High school More than high school
Prevalence of Diabetes Prevalence of Diabetes TodayToday
Prevalence of Diabetes Prevalence of Diabetes TodayToday
Source: International Diabetes Federation (IDF) (2009), “Diabetes Atlas, 4th edition”.
Note: The data are age-standardised to the World Standard Population.
However, the prevalence of chronic diseases such as diabetes
is rising, due to population aging but also to changes in lifestylePrevalence estimates of diabetes, adults aged 20-79 years, 2010
Global projection for the Global projection for the Diabetes Epidemic: Diabetes Epidemic:
2003 – 2025 (millions)2003 – 2025 (millions)
Global projection for the Global projection for the Diabetes Epidemic: Diabetes Epidemic:
2003 – 2025 (millions)2003 – 2025 (millions)
Diabetes Caused by Excessive Diabetes Caused by Excessive Weight per Global Region Weight per Global Region
Diabetes Caused by Excessive Diabetes Caused by Excessive Weight per Global Region Weight per Global Region
Atherosclerosis100
200150
300250
350
-10 -5 0 5 10 15 20 25 300
100
200
50
150
Postprandial glucose
Insulin resistance
Years
At risk fordiabetes
250
GlucoseGlucose(mg/dL)(mg/dL)
%%RelativeRelative
to Normalto NormalInsulin levelb-cell dysfunction
The Increased Atherosclerosis Risk in Type The Increased Atherosclerosis Risk in Type 2 Diabetes Begins in the Prediabetic State2 Diabetes Begins in the Prediabetic StateThe Increased Atherosclerosis Risk in Type The Increased Atherosclerosis Risk in Type 2 Diabetes Begins in the Prediabetic State2 Diabetes Begins in the Prediabetic State
200 mg/dl
126 mg/dl
Fasting glucose
Clinical Diagnosis
Interrelationship Between Interrelationship Between Insulin Resistance, Abdominal Insulin Resistance, Abdominal
Obesity and AtherosclerosisObesity and Atherosclerosis
Interrelationship Between Interrelationship Between Insulin Resistance, Abdominal Insulin Resistance, Abdominal
Obesity and AtherosclerosisObesity and Atherosclerosis
Insulin Resistance Insulin Resistance
H/TH/THyper-Hyper-glycemiaglycemia
Hypertri-Hypertri-glyceridemiaglyceridemia
SmallSmall LDL LDL
LowLow
HDLHDL
AtherosclerosisAtherosclerosis
Endothel.Endothel.dysfunctndysfunctn
Pro-inflam-Pro-inflam-matorymatory
HyperinsulinemicHyperinsulinemicmitogenesismitogenesis
ObesityObesity
Hyperco-Hyperco-agulabilityagulability
Age-adjusted prevalence trends for high blood pressure in Age-adjusted prevalence trends for high blood pressure in Adults age 20 and older by race/ethnicity and sex survey Adults age 20 and older by race/ethnicity and sex survey
(NHANES: 1988-94, 1999-02 and 2003-06).(NHANES: 1988-94, 1999-02 and 2003-06). Source: NCHS and Source: NCHS and NHLBI. NH- non-Hispanic.NHLBI. NH- non-Hispanic.
22.9
37.5 38.2
26.925.025.6
27.0
41.4
27.8
38.5
25.424.827.6
30.3
40.341.9
23.726.4
0
10
20
30
40
50
NH WhiteMen
NH WhiteWomen
NH BlackMen
NH BlackWomen
MexicanAmerican
Men
MexicanAmericanWomen
Pe
rce
nt
of
Po
pu
lati
on
1988-94 1999-02 2003-06
Extent of Awareness, Treatment and Control of High Extent of Awareness, Treatment and Control of High Blood Pressure by Race/Ethnicity and Sex Blood Pressure by Race/Ethnicity and Sex
(NHANES: 1999-2006). Source: NCHS and NHLBI.
76.6
71.8
61.8
41.9
76.9
68.1
40.0
70.1
59.6
34.1
85.3
43.8
57.7
41.8
25.6
69.9
57.9
31.9
0
10
20
30
40
50
60
70
80
90
Awareness Treatment Controlled
Pe
rce
nt
of
Po
pu
lati
on
W
ith
Hy
pe
rte
ns
ion
NH White Men NH White Women NH Black Men
NH Black Women Mexican-American Men Mexican-AmericanWomen
76.6
71.8
61.8
41.9
76.9
68.1
40.0
70.1
59.6
34.1
85.3
43.8
57.7
41.8
25.6
69.9
57.9
31.9
0
10
20
30
40
50
60
70
80
90
Awareness Treatment Controlled
Pe
rce
nt
of
Po
pu
lati
on
W
ith
Hy
pe
rte
ns
ion
NH White Men NH White Women NH Black Men
NH Black Women Mexican-American Men Mexican-AmericanWomen
Trends in mean total serum cholesterol among adolescents ages Trends in mean total serum cholesterol among adolescents ages 12-17 by race, sex, and survey 12-17 by race, sex, and survey
(NHANES: 1976-80, 1988-94, 1999-02, 2003-04, and 2005-06). Source: NCHS and NHLBI.
163161
172171170
166
163165
174
166168
155
163164
156
161 161
157 158
151
161163
160158
135140145150155160165170175180
WhiteMales
BlackMales
WhiteFemales
BlackFemales
Mex.Am.
Males
Mex.Am.
Females
Me
an
To
tal
Blo
od
Ch
ole
ste
rol
1976-80 1988-94 1999-02 2003-04 2005-06
0
1
2
3
CHD mortality (per 1,000)
Fontbonne AM et al. Diabetes Care. 1991;14:461-469.
29 30-50 51-72 73-114 115
Quintiles (pmol) of fasting plasma insulin
P<0.01
CHD Mortality and CHD Mortality and Hyperinsulinemia:Hyperinsulinemia:
Paris Prospective Study (n=943) Paris Prospective Study (n=943)
CHD Mortality and CHD Mortality and Hyperinsulinemia:Hyperinsulinemia:
Paris Prospective Study (n=943) Paris Prospective Study (n=943)
National Diabetes Data Group. Diabetes in America. 2nd ed. NIH;1995.
Atherosclerosis in Atherosclerosis in DiabetesDiabetes
Atherosclerosis in Atherosclerosis in DiabetesDiabetes
~80% of all diabetic mortality75% from coronary atherosclerosis25% from cerebral or peripheral
vascular disease>75% of all hospitalizations for
diabetic complications>50% of patients with newly
diagnosed type 2 diabetes have CHD
~80% of all diabetic mortality75% from coronary atherosclerosis25% from cerebral or peripheral
vascular disease>75% of all hospitalizations for
diabetic complications>50% of patients with newly
diagnosed type 2 diabetes have CHD
Framingham Heart Study 30-Year Follow-Up:Framingham Heart Study 30-Year Follow-Up:CVD Events in Patients With Diabetes CVD Events in Patients With Diabetes
(Ages 35-64)(Ages 35-64)
Framingham Heart Study 30-Year Follow-Up:Framingham Heart Study 30-Year Follow-Up:CVD Events in Patients With Diabetes CVD Events in Patients With Diabetes
(Ages 35-64)(Ages 35-64)
0
2
4
6
8
10
Age-adjusted annual rate/1,000
Men Women
Total CVD
CHD Cardiac failure
Intermittent claudication
Stroke
Riskratio
P<0.001 for all values
Wilson PWF, Kannel WB. In: Hyperglycemia, Diabetes and Vascular Disease.Ruderman N et al, eds. Oxford; 1992.
Rate in non-diabetic population
*P<0.05