Transcript Metabolic Syndrome and atherosclerosis

Dr :Reem Murad
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Syndrome X
Cardiometabolic Syndrome
Cardiovascular Dysmetabolic Syndrome
Insulin-Resistance Syndrome
Metabolic Syndrome
Beer Belly Syndrome
Reaven’s Syndrome
etc.
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Hypertension
Hypertriglyceridemia
Low HDL-cholesterol
Obesity (central)
Impaired Glucose Handling
Microalbuninuria (WHO)
Signs and Symptoms
The more components of the syndrome that you have,
the greater the risks to your health.
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Impaired glucose handling/insulin resistance
Atherogenic dyslipidemia
Endothelial dysfunction
Prothrombotic state
Hemodynamic changes
Proinflammatory state
Excess ovarian testosterone production
Sleep-disordered breathing
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Type 2 diabetes
Essential hypertension
Polycystic ovary syndrome (PCOS)
Nonalcoholic fatty liver disease
Sleep apnea
Cardiovascular Disease (MI, PVD, Stroke)
Cancer (Breast, Prostate, Colorectal, Liver)
Women
cm
>80 increased risk
>88 cm =
Substantially
increased risk
However, these cut points lose their reliability or
predictive power in patients with BMI >35
Men
>94 increased risk
>102 cm =
Substantially
increased risk
Lean MEJ, et al. Lancet;1998:351:853–6
IOTF, 1996
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Dysfunctional adipose tissue due to combined
disorders
Products of dysfunctional adipose tissue
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Elevation in:
 Non-esterified fatty acids  insulin resistance &
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dyslipidemia
Cytokines  proinflammatory state
PAI-1  prothrombotic state
Angiotensinogen  elevated blood pressure
Resistin  insulin resistance
 Reduced adiponectin  insulin resistance, dyslipidemia,
and proinflammatory state
Subccuteneous
Retroperitoneal
Visceral
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Hyperinsulinemic individuals are at risk for
developing diabetes, hyperlipidemia, HTN, &
ultimately cardiovascular disease
Patients with Metabolic Syndrome are 3.5 times
as likely to die from CVD as normal people
Larger,
more buoyant LDL
LDL= 130 mg/dL
Apo B
Small,
dense LDL
LDL= 130 mg/dL
More Apo B
Cholesterol
ester
Less Atherogenic
“Normal”
More Atherogenic
“Insulin Resistance”
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Multifactor theory:
 Structural and functional injury of vascular
endothelium;
 Response to injury of immune cells and smooth
muscle cells;
 The role of lipoproteins in initiation and progression
of lesions;
 The role of growth factors and cytokines;
 The role of repeated thrombosis in lesions
progression.
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The term atherosclerosis, which comes from the Greek
words atheros (meaning “gruel” or “paste”) and
sclerosis (meaning “hardness”),
contributes to more mortality and more serious
morbidity than any other disorder in the western
world.
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The clinical manifestations of atherosclerosis depend on the
vessels involved and the extent of vessel obstruction.
Atherosclerotic lesions produce their effects through:
 narrowing of the vessel and production of ischemia;
 sudden vessel obstruction caused by plaque hemorrhage or
rupture;
 thrombosis and formation of emboli resulting from damage to
the vessel endothelium;
In larger vessels complications are thrombus formation and
weakening of the vessel wall.
In medium-size arteries ischemia and infarction
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The term coronary heart disease (CHD) describes heart disease
caused by impaired coronary blood flow.
In most cases, it is caused by atherosclerosis.
Diseases of the coronary arteries can cause:
 Angina
 Myocardial infarction or heart attack
 Cardiac dysrhythmias
 Conduction defects
 Heart failure
 Sudden death
For a
healthy
person, the
LDL/HDL
ratio is 3.5
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Obesity
Glucose Intolerance
Insulin Resistance
Lipid Disorders
Hypertension
Goals: Minimize Risk of Type 2 Diabetes and
Cardiovascular Disease
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For every 1% rise in Hgb A1c there is an 18%
rise in risk of cardiovascular events & a 28%
increase in peripheral arterial disease
tight blood sugar control in both Type 1 and
Type 2 diabetes reduces risk of CVD
Goals: FSBS - premeal 90-130, postmeal <180.
Hgb A1c <7%
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Exercise
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Weight loss
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Improves CV fitness, weight control, sensitivity to
insulin, reduces incidence of diabetes
Improves lipids, insulin sensitivity, BP levels, reduces
incidence of diabetes
Goals: Brisk walking - 30 min./day
10% reduction in body wt.
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Hypertension:
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Hyperlipidemia:
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ACE inhibitors, ARBs
Others - thiazides, calcium channel blockers, beta
blockers, alpha blockers
Statins, Fibrates, Niacin
Platelet inhibitors:
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ASA, clopidogrel
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A risk factor
Both passive and active exposure harmful
A major risk factor for:
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insulin resistance and metabolic syndrome
macrovascular disease (PVD, MI, Stroke)
microvascular complications of diabetes
pulmonary disease, etc.
Healthy lifestyle changes can prevent the onset of the syndrome.
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Commit to a healthy diet
o A healthy diet includes plenty of fruits and vegetables, choosing lean cuts of
white meat and fish over red meat, avoiding processed or deep-fried dinners,
and eliminating table salt by experimenting with other herbs and spices.
Get moving
o It is important to stay active. Get at least 30 minutes of moderately strenuous
activity on most days of the week is recommended.
Schedule regular check-ups
o This includes assessing blood pressure, cholesterol and blood sugar levels
annually. Early detection of problems can help with formulating lifestyle
modifications.
Insulin
Resistance
Hidden Dangers
Type 2 Diabetes
• Hyperinsulinemia
• IGT
• Dyslipidemia
• Hypertension
• Coagulation abnormality