Reducing Heart Disease Risk in Patients with the Metabolic Syndrome

1. Reducing Heart Disease Riskin Patients with theMetabolic Syndrome

2. Risk Factors for Heart Disease • Physical inactivity • Stress • Obesity • Smoking • Diabetes • High Cholesterol, high triglycerides, low HDL • High blood pressure • High fat diet • Age • Family History • Gender

3. These 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.

4. 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

5. Metabolic Syndrome:What is it? • 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 Grundy SM et al. Circulation. 2005 Sep 12

6. Metabolic Syndrome:What is it? • Has been known in the past as • “Syndrome X” • A more descriptive medical term is • insulin resistance

7. Metabolic Syndrome:What is it? • 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…

8. Metabolic Syndrome:What is it? • The good news... is that evensmall changes in eatinghabits and activity patternscan help improve thefactors associated withthe metabolic syndrome

9. Elevated 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)

10. Advice for Patients with high triglycerides • Reduce weight • Increase physical activity • Increase low glycemic-index foods • reduce carbohydrate intake • increase omega-3 fatty acids

11. 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)

12. Advice for patients withlow HDL • Reduce weight • Increase physical activity • Increase monounsaturated fats • Stop smoking

13. Abdominal 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

15. Advice for patients with abdominal obesity • Reduce weight • Increase physical activity

16. 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)

18. Advice for patients withhigh fasting blood sugar • Reduce weight • Increase physical activity • Reduce carbs • Replace with monounsaturated fat • Increase fiber

19. Blood 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)

20. 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

21. 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

22. Is there a treatment that can improve all 5 features of the metabolic syndrome at once? • TLC! • Therapeutic Lifestyle Change

23. What is Therapeutic Lifestyle Change? • Diet changes to improvecholesterol profile • Daily physical activity • Weight Control • Small changes=BIG REWARDS

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

25. Benefit of Treating the Metabolic Syndrome 23% After 4 years — risk of diabetes reduced by 58% (17–29 CI) 11% (6–15 CI) Intervention Control % with Diabetes Tuomilehto J et al. N Engl J Med 2001;344:1343-1350.

26. 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

27. 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