1 / 73

METABOLIC SYNDROME

METABOLIC SYNDROME. Metabolic Syndrome. Synonyms Insulin resistance syndrome (Metabolic) Syndrome X Dysmetabolic syndrome Multiple metabolic syndrome. Case presentation:. 46-year-old man (for new job) denies: any complaints recent history of illness or injury

mirra
Télécharger la présentation

METABOLIC SYNDROME

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. METABOLIC SYNDROME

  2. Metabolic Syndrome Synonyms • Insulin resistance syndrome • (Metabolic) Syndrome X • Dysmetabolic syndrome • Multiple metabolic syndrome

  3. Case presentation: • 46-year-old man (for new job) • denies: • any complaints • recent history of illness or injury • except: "few aches&epigastric pain on and off." • PMH: • Negative • last P/E: 10 years ago for a job-related injury to his knee • D.HX: • negative

  4. cont.. • F/H: mother and brother having heart disease, hypertension, and obesity. • Social /H: • High-fat, high-cholesterol diet • Moderatetobacco use •  P/E: • moderately obese(central), white man • V/S : • Temp: 37.1°C • HR:88 beats /minute • RR:16 breaths /minute • Average BP :144/90 mm Hg in both arms • Wt: 107.7 kg • Ht: 173 cm • BMI: 36 kg/m2.

  5. Cont... • W/C: 112 cm • The rest of P/E: unremarkable • Diagnostic Assessment Results: • ECG:NL • Fasting lipid profile: • Total C = 282 mg/dLLDL-C = 152 mg/dLHDL-C = 36 mg/dLTG= 248 mg/dL • FBS: 116 mg/dL • CBC:NL • U/A:NL

  6. Metabolic syndrome • combination of medical disorders , increase the risk of developing CVD & diabetes. • Prevalence: • one in five people(U.S) • increases with age • History: • 1950 • 1970

  7. PATHOGENESIS: Endothelial Systemic Complex Dysfunction Inflammation Dyslipidemia TG, LDL HDL Athero- sclerosis Insulin Disordered Resistance Fibrinolysis Hypertension Visceral Obesity Type 2 Diabetes

  8. Metabolic Syndrome Causes • Acquired causes • Overweight and obesity • Physical inactivity • High carbohydrate diets (>60% of energy intake) • Endocrine disorders such as:polycystic ovarian syndrome • Aging • Genetic causes

  9. *Dx: 3 of these R.F †Abd.obes: more highly correlated with metabolic risk factors than BMI. ‡Some men develop metabolic risk factors when circumference is only marginally increased.

  10. Risk factors continues • Overweight and obesity • Sedentary lifestyle • Aging • Diabetes mellitus • Coronary heart disease • Lipodystrophy

  11. Risk factors cont...

  12. THERAPEUTIC GOALS FOR MANAGE OF METABOLIC SYN...

  13. Diabetes mellitus

  14. Overview of Diabetes in the United States

  15. Overall, 20% of the Iranian aged 30yr/old& over at risk of DM more than 1.5 million: DM in Iran the prevalence of DM in Yazd: 7.3% Now,145000pts are affected,estimated to be 400000,in 2030 Prevalence of `DM in 30 yr old & over in various locations of IRAN

  16. Diabetes mellitus • Diabetes mellitus, which is characterized by high concentrations of blood glucose resulting from defects in insulin secretion and/or insulin action • type 2 diabetes • most common : • 90% to 95% • type 1 diabetes: • 5% to 10%. • Other forms( 1% to 2% ): • specific genetic syndromes • surgery • Drugs • Malnutrition • infections

  17. Diabetes mellitus… Who are at risk? ethnic groups Latin Americans African Americans strong F.HX PCOS, or GDM IGT,IFG:(25-40% in5later) dyslipidemia Hypertension central obesity

  18. Prevalence of R.F for DM2 in Iran

  19. Dx & Classification of D.M

  20. CVD &DM: • IN pts with DM: • CVD:primary cause of death(55%) • IHD:40% of death • Risk of mortality 2-4 times higher than others

  21. With Type 2 Diabetes With or Without Previous MI

  22. Treatment goals:D.M… Degree of glycemic control: Preprandial70–-130mg/dL; <110 ideally Postprandial (1 to 2h) <180 minimal; <140 ideally HbA1c <7% minimally; 6% or less if possible in selected patients early in disease course Management of CV risk factors: BP<130/80 LDL <100mg/dL; optional <70mg/dL Non-HDL <130mg/dL; optional <100mg/dL HDL >40mg/dL (men); >50mg/dL (women) Triglycerides <150mg/dL

  23. Treatment continue.. Non-pharmacologic therapy Diet Exercise Intensive lifestyle modification Medical therapy

  24. ABDOMINAL OBESITY

  25. CLASSIFICATION

  26. Dyslipidemia • Elevated Cholesterol, Triglycerides… • Major modifiable R.F for CHD

  27. New Features of ATP III (continued) Screening/Detection: • Complete lipoprotein profile : • Fasting total chol, LDL, HDL, TG • Secondary option: • Non-fasting total cholesterol and HDL • If TC 200 mg/dL or HDL <40 mg/dL: • Proceed to lipoprotein profile

  28. NCEP/ ATP III Lipid Classification STEP1:determine LDL Cholesterol (mg/dL) <100 Optimal 100–129 Near optimal/above optimal 130–159 Borderline high 160–189High 190 Very high

  29. ATP III Lipid Classification (continued) step1 Total Cholesterol (mg/dL): <200 Desirable 200–239 Borderline high 240High HDL –c (mg/dL): <40 low >60 High

  30. New Features of ATP III Step 2: CHD equivalents risk factors: (10-year risk for hard CHD >20%) • Diabetes • Framingham projections of 10-year CHD risk(age,HTN,T-chol&HDL) • metabolic syndrome • Symptomatic carotid artery dx • Peripheral artery dx • Abdominal aortic aneurysm

  31. Step 3 :Major CHD factors other than LDL New Features of ATP III (continued) • Cigarette smoking • HTN : • BP 140/90 mmHg or on Rx • Low HDL chol(<40 mg/dL) • F.H of premature CHD: • CHD in male first degree relative <55 years • CHD in female first degree relative <65 years • Age: • (men 45 years; women 55 years) † HDL cholesterol 60 mg/dL counts as a “negative” risk factor; its presence removes one risk factor from the total count.

  32. Step 4 : initiate therapeutic lifestyle change(TLC)& drug Tx

  33. New Features of ATP III (continued) Treatment: • Therapeutic Lifestyle Changes (TLC) • Drug therapies

  34. Lifestyle … • TLC Diet Reduced intake: • Saturated fats <7% of total calories • Dietary cholesterol <200 mg / day LDL-lowering therapeutic: • Plant sterols (2 g /day) • Viscous (soluble) fiber (10–25 g / day) • Weight reduction • Increased physical activity

  35. Treatment: DIET • Limit intake of food rich in cholesterol and saturated fats

  36. Treatment: DIET • fish more than meat or poultry • Limit intake of egg yolks to 3-4 times a week • more of dried beans, peas and legumes • more cereals and grains

  37. Treatment: EXERCISE • 30-60 min of aerobic exercise 3-4 times a week • Increase physical activity at home and at work

  38. Visit 3 Visit 2 LDL response? not :add drug Tx Visit I LDL response? not: Treatment Lifestyle Therapeutic Lifestyle Changes (TLC): Visit N 6 wks 6 wks 4-6 mo MonitorTLC • saturated fat &chol • moderate ph.act • refere • Reinforce saturated • Increase fiber intake • Refere • Tx MetabolicSyndrome • Intensify wt &ph.act • refere

  39. Medications:

More Related