Reducing Heart Disease Risk in Patients with the Metabolic Syndrome

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Reducing Heart Disease Risk in Patients with the Metabolic Syndrome. Risk Factors for Heart Disease. Physical inactivity Stress Obesity Smoking Diabetes High Cholesterol, high triglycerides, low HDL High blood pressure High fat diet. Age Family History Gender. - PowerPoint PPT Presentation

Transcript of Reducing Heart Disease Risk in Patients with the Metabolic Syndrome

  • Reducing Heart Disease Riskin Patients with theMetabolic Syndrome

  • Risk Factors for Heart DiseaseAgeFamily HistoryGenderPhysical inactivityStressObesitySmokingDiabetesHigh Cholesterol, high triglycerides, low HDLHigh blood pressureHigh fat diet

  • These factors we cannot changeAge: Heart disease risk increases as we get olderFamily history: This is especially powerful if your mother, father, sister, or brother experienced heart disease in their 50s or 60s or youngerGender: Men have a higher risk of heart disease earlier in life. After menopause, women catch up.

  • In partnership with a healthcare provider, these factors are the onesthat we can change...Physical inactivityStressObesitySmokingDiabetesHigh Cholesterol, High triglycerides, low HDLHigh blood pressureHigh fat diet

  • Metabolic Syndrome: What is it? Any 3 out of these 5 features=metabolic syndromeHigh Triglycerides >150 mg./dL Low HDL (good cholesterol) 35 womenFasting blood sugar>100 BP >130/85

    Grundy SM et al. Circulation. 2005 Sep 12

  • Metabolic Syndrome: What is it? Has been known in the past as Syndrome X

    A more descriptive medical term is insulin resistance

  • Metabolic Syndrome: What is it? Having metabolic syndrome at least doubles the risk of heart diseaseMany people with metabolic syndrome go on to develop type 2 diabetesThats the bad news

  • Metabolic Syndrome: What is it? The good news... is that even small changes in eating habits and activity patterns can help improve the factors associated with the metabolic syndrome

  • Elevated Triglyceride LevelTriglyceride is a blood fat related to cholesterolRequires a fasting blood test (12 hours) for accuracy Triglyceride level >150 mg./dL is one feature of the metabolic syndrome*(*Guidelines recently updated to include those with normal triglyceride levels but who are on treatment for same)

  • Advice for Patients with high triglycerides Reduce weightIncrease physical activityIncrease low glycemic-index foodsreduce carbohydrate intakeincrease omega-3 fatty acids

  • High Density Lipoprotein cholesterol (HDL)Known as the good cholesterolHas a protective effect- removes cholesterol from the bloodMetabolic syndrome feature if
  • Advice for patients withlow HDLReduce weightIncrease physical activityIncrease monounsaturated fatsStop smoking

  • Abdominal ObesityTendency to carry ones weight around the waist areaapple shape rather than pear-shapeIncreased waist circumference (these cutpoints may vary in different ethnic groups)>40 inches for men>35 inches for women

  • Advice for patients with abdominal obesityReduce weightIncrease physical activity

  • Elevated fasting blood sugarDiabetes diagnosed when fasting blood sugar > 126 mg./dL (confirmed on second reading)Fasting blood sugar < 100 mg./dL is normalFasting blood sugar > 100 mg./dL is a feature of the metabolic syndrome(*Guidelines recently updated to include those with normal glucose levels but who are on treatment for same)

  • Advice for patients withhigh fasting blood sugarReduce weightIncrease physical activityReduce carbsReplace with monounsaturated fatIncrease fiber

  • Blood PressureOptimal blood pressure is considered 130/>85 is a feature of the metabolic syndrome*(*Those who are on treatment for a history of high blood pressure also meet this criteria)

  • Advice for Patients with high blood pressureReduce weightIncrease physical activity Avoid tobaccoReduce saturated fat intakeReduce sodium intakeIncrease fruits and vegetables2-3 servings of low-fat dairy products dailyLimit alcohol

  • How to treat metabolic syndromeEffective medicines are available to lower triglyceridesEffective medicines to raise HDLEffective medicines to lower blood pressureIf you have diabetes, there are effective medicines to treat

  • Is there a treatment that can improve all 5 features of the metabolic syndrome at once?TLC!Therapeutic Lifestyle Change

  • What is Therapeutic Lifestyle Change?Diet changes to improve cholesterol profileDaily physical activityWeight ControlSmall changes= BIG REWARDS

  • Does Treating the Metabolic Syndrome Make a Difference? Finnish Diabetes Prevention Study522 middle-aged overweight (BMI 31)172 men and 350 womenDuration 3.2 yearsIntervention Group: Individualized counselingReducing weight, total intake of fat and saturated fatIncreasing uptake of fiber, physical activityTuomilehto J et al. N Engl J Med 2001;344:1343-1350.

  • Benefit of Treating the Metabolic SyndromeTuomilehto J et al. N Engl J Med 2001;344:1343-1350.InterventionControlAfter 4 years risk of diabetes reduced by 58%11%23%(615 CI)(1729 CI)% with Diabetes

  • Average weight loss(at the end of one year) inFinnish Diabetes Prevention Project4.2 kg. (about 9 pounds) in the diet and exercise group compared to 0.8 kg. (about 1 3/4 pounds) in the usual care group Additional research studies have confirmed the power of lifestyle changes.Small changes= BIG REWARDS

  • In summary...Many adults develop features of the metabolic syndrome as they reach middle age and beyondReducing weight and increasing physical activity are the 2 strategies that can change each of these factors at the same timeSmall changes can yield big rewards in terms of preventing diabetes and heart disease