Diabetes obesity in patients with COPD Angelo Avogaro

1. Grazie per aver scelto di utilizzare a scopo didattico questo materiale delle Guidelines 2011 libra.Le ricordiamo che questo materiale è di proprietà dell’autore e fornito come supporto didattico per uso personale.

2. Diabetes obesity in patients with COPD Angelo Avogaro

3. Intra-abdominal Obesity, Metabolic Risk Factors and CHD Atherogenic dyslipidemia  Triglycerides  HDL-cholesterol  Cholesterol/HDL-cholesterol ratio "Normal" LDL-cholesterol but  apo B Small, dense LDL and HDL Postprandial hyperlipidemia Inflammation Insulin resistance Insulin resistance Hyperinsulinemia Hyperglycemia Type 2 diabetes Lipid core Thin fibrous cap Thrombotic state  PAI-1  Fibrinogen CORONARY ATHEROSCLEROSIS UNSTABLE PLAQUE Inflammatory state  CRP  Cytokines  risk of acute coronary syndrome Abdominal obesity Metabolic risk factors adapted from Despres, 2004

4. Adverse cardiometabolic effects of products of adipocytes ↑ Lipoprotein lipase Hypertension ↑ Agiotensinogen ↑ IL-6 Inflammation Atherogenicdyslipidaemia ↑ Insulin ↑ FFA Adiposetissue ↑ TNFα ↑ Resistin ↑ Leptin ↑ Adipsin(Complement D) ↑ Lactate Type2 diabetes ↑ Plasminogenactivator inhibitor-1(PAI-1) ↓ Adiponectin Atherosclerosis Thrombosis Lyon 2003; Trayhurn et al 2004; Eckel et al 2005

5. 2001

7. COPD Inflammation May Contribute to Cardiovascular Disease Rennard. Proc Am Thorac Soc. 2005;2:94-100.

8. The metabolic syndrome in patients with chronic obstructive pulmonary disease 38 COPD patients (age: 66 +/- 7 years, [mean +/- SD], FEV1: 43 +/- 16% 34 controlparticipantsmatched for age and gender are included in thisstudy. RESULTS: 47% of COPDpatients and 21% of controlparticipants presentedmetabolicsyndrome. CONCLUSIONS: The presence of metabolicsyndromeisfrequent in patients with COPD whoparticipated in a cardiopulmonaryprogram. Hence, thispopulationshould be considered for screening for the metabolicsyndrome. Marquis K et al, J Cardiopulm Rehabil. 2005

9. Peak YJ at al, Metabolism 2010

10. Log-transformed (log) hs-CRP (A), log interleukin-6 (B), fibrinogen (C), and physical activity level (D) according to GOLD stages and the absence or presence of the metabolic syndrome. Watz H et al. Chest 2009;136:1039-1046

11. Visceral adipose tissue favours systemic inflammation 220 1,3 110 1,3 1,2,3 1,2 200 1 106 1 1 180 1 102 160 Waist girth (cm) 98 Visceral tissue area (cm2) 140 94 120 100 90 (1) (2) (3) (4) (5) (1) (2) (3) (4) (5) Quintiles of PCR Quintiles of PCR Lemieux I et al. Arterioscler Thromb Vasc Biol 2001;21:961-7.

12. Sleep Disorders-Metabolic Syndrome Sleep Fragmentation Sleep Deprivation Metabolic Syndrome Intermittent Hypoxemia Increased Sympathetic Drive Sleep Disorders

13. Homeostasis model assessment in Respiratory Distress Syndrome Punjabi, N. M. et al. Am. J. Epidemiol. 2004 160:521-530; doi:10.1093/aje/kwh26

15. Schematic overview of the distinct steps that comprise leukocyte transendothelial migration van Buul, J. D. et al. Arterioscler Thromb Vasc Biol 2004;24:824-833

16. Risk Factors Rescue Factors Cardiovascular Health Cigarette smoking Diabetes Mellitus Hypercholesterolemia Hypertension Obesity Age Family history of CVD Gender Postprandial Hyperglycemia HDL cholesterol Anti oxidant reserves Endothelial progenitor cells

17. EPC Endothelial cell apoptosis and -regeneration Regeneration Apoptosis Risk factors Apoptosis

18. The biological significance of EPCs What they are? Fadini et al, Diabetes Care 2007

19. The clinicalsignificance of EPCs Disease Marker – Cardiovascularrisk Fadini et al. Eur Heart J 2006 Fadini et al. ATVB 2006

20. The clinicalsignificance of EPCs Disease Marker – Pulmonarydiseases RLD COPD Fadini et al. Stem Cells 2006

21. The clinicalsignificance of EPCs Disease Marker – CVD vs Pulmonarydisease Fadini et al. AJRCMB 2006

22. Fadini et al. Eur Respir J. 2010