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Metabolic Syndrome

Metabolic Syndrome. Yusra Mir, MD Zunairah Syed, MD Harjagjit Maan, MD. Introduction. Metabolic syndrome is a clinically useful tool to identify people at risk for diabetes and cardiovascular disease

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Metabolic Syndrome

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  1. Metabolic Syndrome Yusra Mir, MD Zunairah Syed, MD Harjagjit Maan, MD

  2. Introduction • Metabolic syndrome is a clinically useful tool to identify people at risk for diabetes and cardiovascular disease • It indicates cumulative cardio metabolic risk exerted by abdominal obesity, hyperglycemia, high triglyceride, low high density lipoprotein cholesterol, and high blood pressure

  3. Definition of Metabolic Syndrome According 2001 NCEP/ATP III, the criteria to define metabolic syndrome are presence of any three of the following five traits: • Abdominal obesity, defined as waist circumference in men > 40 inches and women > 35 inches • Serum triglycerides ≥ 150 or drug treatment for elevated triglycerides • Serum HDL cholesterol < 40 mg/dl in men and < 50 mg/dl in women or drug treatment for low HDL-C • Blood pressure ≥ 130/85 mmHg or drug treatment for elevated blood pressure • Fasting plasma glucose ≥ 100 mg/dl or drug treatment for elevated blood glucose

  4. Background • According to the 3rd National Health and Nutrition Examination Survey (NHANES III, 1988 to 1994): • Overall prevalence was 22%, with an age-dependent increase (6.7, 43.5, and 42.0 % for ages 20 to 29, 60 to 69, and > 70 years, respectively) • Mexican-Americans had the highest age-adjusted prevalence (31.9%) • Among Mexican-Americans and African-Americans, the prevalence was higher in women than in men (57 and 26 % higher, respectively) • Incidence of metabolic syndrome has increased • The NHANES 1999-2002 database shows 34.5% of participants met ATP III criteria as compared to 22% in 1988 to 1994

  5. Materials & Method • In order to know the performance of the Family Care Clinic in screening and treatment of Metabolic Syndrome, we reviewed a total of 195 charts using ATP III 2001 criteria

  6. Inclusion Criteria • Inclusion Criteria • All the patients who come to family care clinic • Age >= 18

  7. Results & Analysis

  8. Detailed Study data • Metabolic Syndrome (Projected) row also includes the patients with • DM & HTN • HTN & Hyperlipidemia

  9. # of Patients by Disease & Education

  10. % of Patients by Disease & Education

  11. Patients & Education

  12. Discussion In 2001, ATP III recommended two major therapeutic goals in patients with syndrome (goals reinforced by a report from the American Heart Association and National Institutes of Health) • Treat underlying causes (overweight/obesity and physical inactivity) by intensifying weight management and increasing physical activity • Treat cardiovascular risk factors if they persist despite lifestyle modification There is no direct evidence that attempting to prevent type 2 diabetes and CVD by treating metabolic syndrome is as effective as attaining the above goals. It is possible to treat insulin resistance with drugs that enhance insulin action. However, the ability of such an approach to improve outcomes compared to weight reduction and exercise alone is not yet well supported by clinical trials.

  13. Therapeutic Goals for Management of Metabolic Syndrome Lifestyle Risk Factors

  14. Therapeutic Goals for Management of Metabolic Syndrome Metabolic Risk Factors

  15. Examples of Lifestyle Modifications Source: Geriatric Aging 2007 referenced in “Preventing Diabetes and Cardiovascular Disease in Older Adults” (medscape.com)

  16. Examples of Moderate Physical Activity Source: Adapted from National Heart, Lung, and Blood Institute. Geriatric Aging 2007 referenced in “Preventing Diabetes and Cardiovascular Disease in Older Adults” (medscape.com)

  17. Conclusions • Metabolic Syndrome is becoming increasingly common in our patient population • It is not being adequately recognized and treated in our outpatient clinics • We recommend the following strategies to improve diagnosis and treatment of metabolic syndrome: • Nursing staff measure waist circumference and calculate BMI for every patient prior to MD evaluation • The “Therapeutic Goals for Management of Metabolic Syndrome” (as shown on slide 10) should be available to doctors for easy reference • Examples of Lifestyle Modifications (slide 11) and Moderate Physical Activity (slide 12) should be provided to all patients keeping in mind the high prevalence of metabolic syndrome in our patient population • Metabolic syndrome to be added to ICD code 9 in the yellow billing form

  18. Bibliography • Up-To-Date • E-Medicine • Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. JAMA 2001; 285:2486-97. • The Diabetes Prevention Program Research Group. Diabetes Care 2000; 23:1619-29. • Intensive Lifestyle Changes for Reversal of Coronary Heart Disease. JAMA 1998;280:2001-7.

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