Reducing Heart Disease Riskin Patients with theMetabolic Syndrome

Reducing Heart Disease Riskin Patients with theMetabolic Syndrome

Risk Factors for Heart DiseaseRisk Factors for Heart Disease

• Age• Family History• Gender

• Age• Family History• Gender

• Physical inactivity

• Stress

• Obesity

• Smoking

• Diabetes

• High Cholesterol, high triglycerides, low HDL

• High blood pressure

• High fat diet

• Physical inactivity

• Stress

• Obesity

• Smoking

• Diabetes

• High Cholesterol, high triglycerides, low HDL

• High blood pressure

• High fat diet

These factors we cannot changeThese factors we cannot change

• Age: Heart disease risk increases as we get older

• Family history: This is especially powerful if your mother, father, sister, or brother experienced heart disease in their 50’s or 60’s or younger

• Gender: Men have a higher risk of heart disease earlier in life. After menopause, women catch up.

• Age: Heart disease risk increases as we get older

• Family history: This is especially powerful if your mother, father, sister, or brother experienced heart disease in their 50’s or 60’s or younger

• Gender: 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...

In partnership with a healthcare provider,

these factors are the onesthat we can change...

• Physical inactivity• Stress• Obesity• Smoking• Diabetes• High Cholesterol, • High triglycerides,

low HDL• High blood pressure• High fat diet

• Physical inactivity• Stress• Obesity• Smoking• Diabetes• High Cholesterol, • High triglycerides,

low HDL• High blood pressure• High fat diet

• Any 3 out of these 5 features=metabolic syndrome– High Triglycerides >150 mg./dL – Low HDL (“good cholesterol”)

• <40 mg./dL for men• <50 mg./dL for women

waist circumference• >40” men• >35” women

– Fasting blood sugar>100 – BP >130/85

• Any 3 out of these 5 features=metabolic syndrome– High Triglycerides >150 mg./dL – Low HDL (“good cholesterol”)

• <40 mg./dL for men• <50 mg./dL for women

waist circumference• >40” men• >35” women

– Fasting blood sugar>100 – BP >130/85

Metabolic Syndrome: What is it?

Metabolic Syndrome: What is it?

Grundy SM et al. Circulation. 2005 Sep 12

Metabolic Syndrome:

What is it?

Metabolic Syndrome:

What is it?

• Has been known in the past as – “Syndrome X”

• A more descriptive medical term is – insulin resistance

• Has been known in the past as – “Syndrome X”

• A more descriptive medical term is – insulin resistance

• Having metabolic syndrome at least doubles the risk of heart disease

• Many people with metabolic syndromego on to develop type 2 diabetes

• That’s the bad news…

• Having metabolic syndrome at least doubles the risk of heart disease

• Many people with metabolic syndromego on to develop type 2 diabetes

• That’s the bad news…

Metabolic Syndrome:

What is it?

Metabolic Syndrome:

What is it?

• The good news... is that evensmall changes in eatinghabits and activity patternscan help improve thefactors associated withthe metabolic syndrome

• The good news... is that evensmall changes in eatinghabits and activity patternscan help improve thefactors associated withthe metabolic syndrome

Metabolic Syndrome:

What is it?

Metabolic Syndrome:

What is it?

Elevated Triglyceride LevelElevated Triglyceride Level

• Triglyceride is a blood fat related to cholesterol

• Requires 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)

• Triglyceride is a blood fat related to cholesterol

• Requires 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

Advice for Patients with high triglycerides

– Reduce weight

– Increase physical activity

– Increase low glycemic-index foods

– reduce carbohydrate intake

– increase omega-3 fatty acids

– Reduce weight

– Increase physical activity

– Increase low glycemic-index foods

– reduce carbohydrate intake

– increase omega-3 fatty acids

High Density Lipoprotein cholesterol (HDL)

High Density Lipoprotein cholesterol (HDL)

• Known as the good cholesterol

• Has a protective effect- removes cholesterol from the blood

• Metabolic syndrome feature if

– <40 mg./dL in men*

– <50 mg./dL in women*

(*Guidelines recently updated to include those with normal HDL levels but who are on treatment for same)

• Known as the good cholesterol

• Has a protective effect- removes cholesterol from the blood

• Metabolic syndrome feature if

– <40 mg./dL in men*

– <50 mg./dL in women*

(*Guidelines recently updated to include those with normal HDL levels but who are on treatment for same)

Advice for patients withlow HDL

Advice for patients withlow HDL

– Reduce weight

– Increase physical activity

– Increase monounsaturated fats

– Stop smoking

– Reduce weight

– Increase physical activity

– Increase monounsaturated fats

– Stop smoking

Abdominal ObesityAbdominal Obesity

• Tendency to carry one’s weight around the waist area

• “apple shape” rather than “pear-shape”

• Increased waist circumference (these cutpoints may vary in different ethnic groups)

– >40 inches for men

– >35 inches for women

• Tendency to carry one’s weight around the waist area

• “apple shape” rather than “pear-shape”

• Increased waist circumference (these cutpoints may vary in different ethnic groups)

– >40 inches for men

– >35 inches for women

Advice for patients with abdominal obesity

Advice for patients with abdominal obesity

• Reduce weight

• Increase physical activity

• Reduce weight

• Increase physical activity

Elevated fasting blood sugar

Elevated fasting blood sugar

• Diabetes diagnosed when fasting blood sugar > 126 mg./dL (confirmed on second reading)

• Fasting blood sugar < 100 mg./dL is normal

• Fasting 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)

• Diabetes diagnosed when fasting blood sugar > 126 mg./dL (confirmed on second reading)

• Fasting blood sugar < 100 mg./dL is normal

• Fasting 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 sugarAdvice for patients withhigh fasting blood sugar

– Reduce weight

– Increase physical activity

– Reduce carbs

– Replace with monounsaturated fat

– Increase fiber

– Reduce weight

– Increase physical activity

– Reduce carbs

– Replace with monounsaturated fat

– Increase fiber

Blood PressureBlood Pressure

• Optimal blood pressure is considered <120/<80 mmHg.

• BP >140/90 = hypertension

• Prehypertension 120-139/80-89

• BP >130/>85 is a featureof the metabolic syndrome*

(*Those who are on treatment for a history of high blood pressure also meet this criteria)

• Optimal blood pressure is considered <120/<80 mmHg.

• BP >140/90 = hypertension

• Prehypertension 120-139/80-89

• BP >130/>85 is a featureof 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 pressure

Advice for Patients with high blood pressure

– Reduce weight

– Increase physical activity

– Avoid tobacco

– Reduce saturated fat intake

– Reduce sodium intake

– Increase fruits and vegetables

– 2-3 servings of low-fat dairy products daily

– Limit alcohol

– Reduce weight

– Increase physical activity

– Avoid tobacco

– Reduce saturated fat intake

– Reduce sodium intake

– Increase fruits and vegetables

– 2-3 servings of low-fat dairy products daily

– Limit alcohol

How to treat metabolic syndrome

How to treat metabolic syndrome

• Effective medicines are available to lower triglycerides

• Effective medicines to raise HDL

• Effective medicines to lower blood pressure

• If you have diabetes, there are effective medicines to treat

• Effective medicines are available to lower triglycerides

• Effective medicines to raise HDL

• Effective medicines to lower blood pressure

• If 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?

Is there a treatment that can improve all 5 features of the metabolic syndrome at once?

• TLC!

• Therapeutic Lifestyle Change

• TLC!

• Therapeutic Lifestyle Change

What is Therapeutic Lifestyle Change?

What is Therapeutic Lifestyle Change?

• Diet changes to improvecholesterol profile

• Daily physical activity

• Weight Control

• Small changes=BIG REWARDS

• Diet changes to improvecholesterol profile

• Daily physical activity

• Weight Control

• Small changes=BIG REWARDS

Does Treating the Metabolic Syndrome Make a Difference?

Finnish Diabetes Prevention Study

Does Treating the Metabolic Syndrome Make a Difference?

Finnish Diabetes Prevention Study

• 522 middle-aged overweight (BMI 31)

– 172 men and 350 women

– Duration 3.2 years

• Intervention Group: Individualized counseling

– Reducing weight, total intake of fat and saturated fat

– Increasing uptake of fiber, physical activity

• 522 middle-aged overweight (BMI 31)

– 172 men and 350 women

– Duration 3.2 years

• Intervention Group: Individualized counseling

– Reducing weight, total intake of fat and saturated fat

– Increasing uptake of fiber, physical activity

Tuomilehto J et al. N Engl J Med 2001;344:1343-1350.

Benefit of Treating the Metabolic SyndromeBenefit of Treating the Metabolic Syndrome

Tuomilehto J et al. N Engl J Med 2001;344:1343-1350.

0%

5%

10%

15%

20%

25%

InterventioInterventionn

ControControll

After 4 After 4 years — years — risk of risk of diabetes diabetes reduced reduced by by 58%

11%11%

23%23%

(6–15 CI)

(17–29 CI)(17–29 CI)

% with Diabetes% with Diabetes

Average weight loss(at the end of one year) inFinnish Diabetes Prevention

Project

Average weight loss(at the end of one year) inFinnish Diabetes Prevention

Project

• 4.2 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 confirmedthe power of lifestyle changes.

• Small changes= BIG REWARDS

• 4.2 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 confirmedthe power of lifestyle changes.

• Small changes= BIG REWARDS

In summary...In summary...

• Many adults develop features of the metabolic syndrome as they reach middle age and beyond

• Reducing weight and increasing physical activity are the 2 strategies that can change each of these factors at the same time

• Small changes can yield big rewards in terms of preventing diabetes and heart disease

• Many adults develop features of the metabolic syndrome as they reach middle age and beyond

• Reducing weight and increasing physical activity are the 2 strategies that can change each of these factors at the same time

• Small changes can yield big rewards in terms of preventing diabetes and heart disease