Rachel McLaughlinPharmD candidate

University of GeorgiaNovember 6, 2012

Cardiometabolic Syndrome in Elderly Women

Metabolic Syndrome

ATP III defined a multiplex risk factor for cardiovascular disease (CVD)

Abdominal obesity (increased waist circumference) Dyslipidemia (raised TGs and low HDL) Elevated blood pressure Insulin resistance +/- glucose intolerance Proinflammatory state (elevated CRP) Prothrombotic state (elevated plasma plasminogen

activator inhbitor and prothrombin)

Metabolic Syndrome

Underlying CVD risk factors Obesity, physical inactivity, atherogenic diet

Major risk factors Cigarette smoking, hypertension, high LDL, low

HDL, family history of premature CHD, aging Emerging risk factors

High TGs, small LDL particles, insulin resistance, glucose intolerance, proinflammatory state, prothrombotic state

Metabolic Syndrome

At least three of the following:

Metabolic Syndrome

Metabolic Syndrome

Increase in risk of CVD outcomes with increasing number of traits

CVD is the primary clinical outcome, but MetS also increases risk for type 2 diabetes and susceptible to polycystic ovary disease, fatty liver, cholesterol gallstones, asthma, sleep disturbances and some cancers

Age- and sex-specific prevalence and ten-yearrisk for cardiovascular disease of all 16 risk factor

combinations of the metabolic syndrome -A cross-sectional study

Cardiovascular Diabetology, August 2010

Methods German Metabolic and Cardiovascular Risk Project

(GEMCAS) data from 2005

35,869 participants Ages 18-99, 61% women

Physicians recorded DM and CVD histories and assessed MetS risk factors according to a standardized assessment

Analyzed all 16 combinations of MetS risk factors association with 10-year risk of fatal and nonfatal MI

Calculated age-standardized prevalence rates to compare CV comorbidities prevalence with different combinations

Results

Results

Most frequent combination in both men and women: WC-BP-GL

More frequent in women than men: WC-HDL-BP 10% vs 3%

In women, the 8 combinations with highest prevalence all included BP and 5 out of 8 included WC

Results

PROCAM analysis of 10-year risk for MI Much higher in men than women Women without MetS: 1.2% ; with: 2.3% Highest risk combos for women: TG-HDL-BP-GL,

WC-TG-HDL-BP, and all five traits combined ESC score: 10-year risk of fatal MI

Women without MetS: 1.2% ; with: 1.8% Highest risk combos for women: TG-HDL-BP-GL,

WC-TG-HDL-BP

Discussion

There was a substantial influence of age and gender on the prevalence of combinations

Every GL combo more prevalent in elderly Higher rates of WC in women

Each combination of MetS may not uniformly increase CV risk

HDL and BP frequent in high risk groups Treat these as higher risk factors than the others??

Body composition and its association with cardiometabolic risk factors in the elderly: A

focus on sarcopenic obesity

Archives of Gerontology and Geriatrics: September 2012

Methods 2943 Korean subjects 60 years or older Body composition categorized into four groups:

sarcopenic obese, sarcopenic nonobese, nonsarcopenic obese, and nonsarcopenic nonobese

Sarcopenia = appendicular skeletal muscle mass divided by weight <1 SD below the mean for young adults

Obesity = BMI >25 kg/m2 Measured cardiometabolic risk factors

BP, glucose intolerance, lipid profiles, inflammatory markers, vitamin D level

Results

Sarcopenic obese group had most insulin resistance, metabolic syndrome, and CVD risk factors

Lowest HDL and vitamin D levels in the sarcopenic obese group

BP, glucose, lipid profiles -risk factors for CVD- significantly associated with the obese subjects

Discussion

Skeletal muscle is a primary tissue responsible for insulin-mediated glucose disposal so muscle loss causes diminished glucose disposal

High fat mass secretes proinflammatory adipocytokines

We need to focus on both obesity and muscle loss

What do we do? Obesity

ATP III recommends tackling this first: lowers cholesterol, raises HDL, lowers blood pressure and glucose

Lose 10% of body weight Reinforce with physical activity... help with

sarcopenia Insulin resistance Blood pressure Lipids

Several drugs will also lower CRP levels

For women, especially look at waist circumference, low HDL, high triglycerides and blood pressure as these caused the highest CV risk in elderly women

As people age, look carefully for signs of insulin resistance and treat appropriately

Exercise!

References

1. Chung, Ji-Youn, Hee-Taik Kang, Duk-Chul Lee, Hye-Ree Lee, Yong-Jae Lee. Body composition and its association with cardiometabolic risk factors in the elderly: A focus on sarcopenic obesity. Archives of Gerontology and Geriatrics. September 2012.

2. Grundy, Scott, Brewer, Jr,H. Bryan, Cleeman, James, Smith, Jr, Sidney, and Lenfant, Claude. Definition of Metabolic Syndrome: Report of the National Heart, Lung, and Blood Institute/ American Heart Association Conference on Scientific Issues Related to Definition. Circulation. 2004; 109:433-438.

3. Moebus, Susanne, Balijepalli, Chakrapani, Lösch Christian, Laura Göres, Bernd von Stritzky, Bramlage, Peter, Jürgen Wasem, Karl-Heinz Jöckell. Age- and sex-specific prevalence and ten-year risk for cardiovascular disease of all 16 risk factor combinations of the metabolic syndrome - A cross-sectional study. Cardiovascular Diabetology. 2010: 9:34.