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
Top Related