K5 - Metabolic Syndrome

8/18/2019 K5 - Metabolic Syndrome

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Pugud Samodro


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Eskil Kylin 1923 – HT, Glucose, UA Reaven 1988 – named Syndome ! "#R$

%H& de'ini(ion)1998 – *e(a+olic syndome

-E.)AT. ### – 2//1 – *S – s(on0 - Risk is( %old -on0ess on #RS – ov 2//3

Second %old -on0ess on #RS – 2//

2//4 5uael a+ou( (6e 7od syndome e7 #: de'ini(ion 2//; ) consensus


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*e(a+olic Syndome "*S$

#nsulin Resis(ance Syndome "#RS$

Syndome ! "*e(a+olic$, :eadly 5ua(e(

:ysme(a+olic Syndome, >?>

Clustering of CV Risk Factors


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IR BB

MS

CVD

DMSmoke


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Insulin Resistance

Obesity DiabetesMetabolic Syndrome

Cardio Vascular Disease (CVD)

2 x 4 x

Reilly *. e( al –

-icula(ion 2//3@ 1/8 14;)1441


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A-E .osi(ion S(a(emen( on #RS

Endoc .ac(? 2//3@9"3$


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E(iolo0y – no( 'ully elucida(ed #nsulin Resis(ance

AcBuied causes

&ve7ei06( and cen(al o+esi(y

.6ysical inac(ivi(y, a0in0, e(6nici(y

Hi06 -H& die(s "C;/D$

.oin'lamma(oy s(a(e, 6omones

.oly Genic causes


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I!" I#

IR" Insulin

Dysli$idemia

%y$ertension&D" Vessel

Visceral obesity

'ro Inlammatory

'ro !rombotic

IncreaseIncreasedd

CV RiskCV Risk


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#nsulin esis(ance – Hyeinsulinemia

A+d? &+esi(y " WC, WC / ht ratio), BMI

Hye0lycemia – #G, #GT, T2:*

Hye(ension, Endo(6elial :ys'unc(ion "E:$

:ysliidemia " TG, sF:F, H:F$

.o)in'lamma(oy s(a(e " -R., T)α, #F);$

.o)coa0ulan( s(a(e " .A#)1, i+ino0en$

.ema(ue a(6eoscleosis, -A:


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HDL

CentralObesity

TG

Hyper-

tension

FPG


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Subcutaneous fat

Abdominal muscle

layer

Intra-abdominal fat

M. Davidson, MD.

Is this correct?


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ClinicalClinicalMeasureMeasure

WHOWHO(1998)(1998)

EGIR EGIR (1999)(1999)

ATP IIIATP III(2001)(2001)

AACEAACE(2003)(2003)

IDID(200!)(200!)

InsulinInsulin

Resis"anceResis"ance

IGT,IFG,T2DM orIGT,IFG,T2DM or

Lower insulin sensitivityLower insulin sensitivity

Plus any 2 of the followingPlus any 2 of the following

Plasma InsulinPlasma Insulin

> 75> 75thth er!entile er!entile

Plus any 2 of thePlus any 2 of thefollowingfollowing

"one, #ut any $ of "one, #ut any $ of

the following 5the following 5

FeaturesFeatures

IGT or IFG lus anyIGT or IFG lus any

of following %ase& onof following %ase& on

!lini!al 'u&gement!lini!al 'u&gement

"one "one

#$%$%&

Wei'"Wei'"

Men ( )*+ > -.Men ( )*+ > -.

)omen ( )*+ > -/5)omen ( )*+ > -/5

0n&1or #MI > $ g1m0n&1or #MI > $ g1m22

)3)3 >>.4 !m in men.4 !m in men

r r

>>/ !m in women/ !m in women

)3)3 >> 62 !m in men62 !m in men

r r

>> // !m in women// !m in women

#MI#MI >> 25 g1m25 g1m22 In!rease )3In!rease )3

oulation se!ifi!8oulation se!ifi!8

Plus any 2 of thePlus any 2 of thefollowingfollowing

i*i%i*i% TG> 65 mg1-&l orTG> 65 mg1-&l or*DL93:$5 mg1&l in men*DL93:$5 mg1&l in men

r : $. mg1&l in womenr : $. mg1&l in women

TGTG >>65 mg1&l ;65 mg1&l ;or or

*DL93 : $. mg1&l*DL93 : $. mg1&l

In men or womenIn men or women

TG> 65 mg1-&l orTG> 65 mg1-&l or

*DL93:4 mg1&l in men*DL93:4 mg1&l in men

r : 5 mg1&l in womenr : 5 mg1&l in women


*DL93:4 mg1&l in*DL93:4 mg1&l inmenmen

r : 5 mg1&l inr : 5 mg1&l inwomenwomen


*DL93:4 mg1&l in men*DL93:4 mg1&l in men

r : 5 mg1&l in womenr : 5 mg1&l in women

#l$$%#l$$%

PressurePressure

>> 641. mm*g641. mm*g >> 641. mm*g641. mm*g

or non hyertensionor non hyertension

>> 6$1/5 mm*g6$1/5 mm*g 6$1/5 mm*g6$1/5 mm*g >> 6$ mm*g systoli! or6$ mm*g systoli! or

>> /5 mm*g &iastoli! or /5 mm*g &iastoli! or "on hyertention +


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*aist Circum

+, (M)" -, (#)

!ri.lycerides /01, m.

%D 34, (M) 3 1, (#)

Dys.lycemia #' /0,, or DM

%y$ertension /0, or -1

Rx5 or any o te abo6e conditions

2 of5


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Features Insulin ResistanceHyperglycemia ↑ PPBG, Usually FBG is N

Obesity, ↑ WC, ACN BI ! "#, WC ! $%, ACN&

↑ 'G, ( H)*, ↑ s*)* )yslipi+emia Present

Cluster - metablic -actrs etablic .yn+rme

Hypertensin /!0#%12%3 Usually is a -eature

Recent 4eig5t c5ange Increase

Fasting C pepti+e 1 Insulin Increase+ /HOA3

'reatment 67ercise, .ensiti8ers


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-an 7e measue insulin esis(ance es I

#( 7ill +e o' use (o con'im #R

as(in0 -).e(ide levels,


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Normal Visceral Aiposity

Courtesy of Wilfred Y. Fui!oto, M".


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#di$onectin

↑ Insulin%ensiti&ity

↓ FF#

In'u(

↓ VascularIn'a!!ation

↓ lucose ↓ *

↑ Insulin%ensiti&ity

↑ FFAO!iation

#di$ose

*issue

↑ FFAO!iation

↓ TG

(Ouchi N, et al, Curr Opin in Lipidol 2003)

ADIPONECTINADIPONECTIN


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7O $roduction Vasoconstriction

#da$ted fro! %tein+erg et al. Diabetes. -0123-43.

ThiazolidinedionesThiazolidinediones

IRIR

Shear stressShear stress

Inreased viseral !atInreased viseral !at

Inreased li"ol#sisInreased li"ol#sis

Inreased $$A levelsInreased $$A levels

%%

EndotheliumEndothelium

Inreased TN$αInreased TN$α

%%

Dereased adi"onetinDereased adi"onetin

%%

%%


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5he$atic5he$atic

li$ase)li$ase)

Fat CellsFat Cells 6i&er6i&er

7idney7idneyInsulinInsulin

IRIR 88

5C9*:)5C9*:)

C9C9

* *

#$o B#$o B V6"6V6"6

5C9*:)5C9*:)

"6"6

5li$o$rotein or he$atic li$ase)5li$o$rotein or he$atic li$ase)

s6"6s6"66"66"6

* *#$o #;3#$o #;3

* *C9C9

FF#FF#

V6"6V6"6


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Low HDL


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AbominalObesity Insulin

Resistance

6i$ids andB: control


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'rimary'rimary SecondarySecondary Dru. RxDru. Rx

Total Lifestyle

Calorie

restriction

P"ysical

Acti#ity

C"an$e in

Diet

TG% sLDL

LDL & Apo

'

HDL

Attain $oal 'P

PPA(

-Fibrates

)tatins f*ll

ose

Niacin%

Aspirin

AC+,A('%


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8C&98RB

)tatins% Fibrate

+!ercise

lita:onesetformin

Calorie


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*e(a+olic syndome is a 6idden volcano

Evalua(e evey one C24 yeas o' a0e 'o *S

&ne mani'es(a(ion – sceen 'o all (6e es(

%- mus( +e measued ou(inely like (akin0


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"9MI 69 6I*%

K5 - Metabolic Syndrome

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