Cardio Metabolic Syndrome

7/30/2019 Cardio Metabolic Syndrome

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Cardiometabolic syndrome

Paul DromgooleRGN, RNMH , MSc Diabetes , PGCert Ed

Independent Lecturer Practitioner


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What is Type 2 diabetes?

A progressive metabolic disorder

characterised by:

Insulinresistance

Type 2

diabetes

-celldysfunction

Adapted from: Beck-Nielson H et al. J Clin Invest1994;94:17141721 and Saltiel AR, Olefsky JM. Diabetes

1996;45:16611669


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Type 2 diabetes Diagnostic

criteria

11.1

7.8

7.0

6.1

T2DM

Impaired glucose

tolerance (IGT)

T2DM Normal

Impaired Fasting Normalglycaemia (IFG)

Normal Normal

Fasting non-fasting2 hours post OGTT


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Insulin resistance and insulin

hypersecretion precede Type 2 diabetes

Insulin Insulin Macrovascularsensitivity secretion disease

30% 50% 50%

50% 70100% 40%

70% 150% 10%

100% 100%

Type 2diabetes

Impaired glucosetolerance

Impaired glucose

metabolism

Normal glucose

metabolism

Adapted from: Beck-Nielsen H, Groop LC. J Clin Invest1994;94:17141721


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Why does Type 2 diabetes if

not effectively managed,lead to such macrovsaculardisease?


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Obesity and Increasing Age in UK

pop

ulation

>30

kg/m2

Percentof

withBMI

Men Women

302520151050

16-24 25-34 35-44 45-54 55-64Age groups (years)

Department of Health. Health Survey for England. Adult Data 1993-1998.


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Waist circumference


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Type 2 Diabetes and visceralfat or

The perils of the pot belly!

but whats the connectionwith cardiovascular risk?


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Visceral Fat metabolically active!!

FFAs

TNF a

IL - 6PAI 1

Cytokines LeptinRAS

Adiponectin

DyslipidaemiaInsulin signalling

Endothelial dysfunctionPro-inflammatory (CRPs)

Pro-thrombosisSNS (>BP)

Angiotensin II (>BP)

Insulin sensitisingAnti-inflammatoryAnti-atheromatic


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Type 2 Diabetes and visceral fat

Visceral fat becomes metabolically active in obesity,

leading to increased FFAs and increased production of arange of inflammatory agents, adipokines and cytokines.

Leading to insulin resistance, hyperglycaemia, increased

cardiovascular risk and leading to the term cardiometabolic

state


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Race-ethnicity specific waist circumference

cut offs for identifying CVD risk factors

O

ddsratio

forCVDr

iskfactors

Odds ratio and WC in men2018161412 Black10 Hispanic8 White642

0

76 80 84 88 92 96 100 104 108 112 116 120 124 128 132 136 140 144 Waist circumference (cm)

Am J Clin Nutrition 2005; 81: 409-15


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Race-ethnicity specific waist circumference

cut offs for identifying CVD risk factors

Odds ratio and WC in women2018

fa

ctors

1614

risk

CVD

12

for 10ratio

8

Odds

6420

62 66 70 74 78 82 86 90 94 98 102 106 110 114 118 122 126Waist circumference (cm)

Am J Clin Nutrition 2005; 81: 409-15

BlackHispanicWhite


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Waist Circumference

Interheart Study: Waist circumference a muchbetter predictor of CV risk than BMI.

Yusuf S et al (2004) Lancet 364:912-914


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Waist circumference targets

Increased risk Substantiallyincreased risk

Men >= 94 cm >= 102 cm

Asian men * >= 90 cm

Women >= 80 cm >= 88 cm

Asian women * >= 80 cm

* Cut off values of risk for individuals of Asian origin have been set at a lowerwaist measurement (WHO available atwww.diabetes.com.au/pdf)


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Waist measurement risk


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Whats in a name?

Reavens syndrome; Syndrome X; Cardiometabolicsyndrome; Insulin Resistance Syndrome.


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Metabolic syndrome (IDF definition)

Central obesity plus and 2 of the following:

Trigs 1.7 mmols/L

HDL < 1.03 males< 1.29 femalesOr on lipid lowering agents

BP 130 / 85Or present / previous treatment of hypertension

FPG >5.6 mmols/lOr previously treated T2DMFPG > 5.6 mmols/L OGTT stronglyrecommended


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San Antonio Heart Study(Metabolic Syndrome as Predictor of Type 2 Diabetes)

2,569 patient epidemiological study looking at DMdiagnostic criteria on prediction of DM and predictionof CV risk.

Participants who did not have T2DM at entry to

study but went on to develop T2DM by end of 8years follow up had:

Substantially higher total cholesterol LDL and trigsand lower HDL

Increased BMI

Hypertension Than those who did not go on to develop T2DM.

This led to the ticking click hypothesis for CHD

Vasudevan A R, & Ballentyne C (2005) Clinical Cornerstone 7 [2/3] 7-16


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Botnia Study(Metabolic consequences of a family history of NIDDM)

3,606 first degree relatives of T2DM patients in Western Finland

Follow-up period 7 years Cardiovascular mortality was 12% in individuals with metabolic

syndrome (MetS) (defined by WHO criteria) compared with 2.2 %

in individuals without. In all subjects, a history of CHD, MI, and stroke was morecommon in those with the Met S than it was in those without (P

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Cardio Metabolic Syndrome