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Update on the Metabolic Syndrome
Steven Haffner, MD
Metabolic Syndrome Increases Risk for CHD and Type 2 Diabetes
High Risk of Impaired Glucose Tolerance and Type 2 Diabetes by OGTT in Post-MI Patients without Known Diabetes
Increased Metabolic Syndrome in Prediabetic Subjects: Baseline Risk Factors in Subjects with Normal Glucose Tolerance at Baseline according to Conversion Status at
8-Year Follow-up: San Antonio Heart Study
Elevated Risk of CVD Prior to Clinical Diagnosis of Type 2 Diabetes:
Nurses' Health Study
Risk of Major CHD Event Associated with Insulin Quintiles in Nondiabetic Subjects: Helsinki Policemen Study
CVD Risk Factors across HOMA-IR Quintiles:San Antonio Heart Study (Phase II)
Definitions of the Metabolic Syndrome
Definition of Metabolic Syndrome:
According to Underlying Causes
Therapeutic Implications:According to Underlying Causes
ATP III:The Metabolic Syndrome
Diagnosis is established when ?3 of these risk factors are present
Prevalence of the NCEP Metabolic Syndrome: NHANES III by Age
Prevalence of the NCEP Metabolic Syndrome:NHANES III by Sex and Race/Ethnicity
Prevalence of CHD by the Metabolic Syndrome and Diabetes in the NHANES Population Age 50+
ATP III Metabolic Syndrome:
Therapeutic Implications
Different Components of the NCEP Metabolic Syndrome Predict CHD:NHANES
Different Components of the NCEP Metabolic Syndrome Predict Diabetes:San Antonio Heart Study
WHO Metabolic Syndrome Definition 1999:Based on Clinical Criteria
Must Insulin Resistance be Present for a Patient to Have the Metabolic Syndrome?
WHO Metabolic Syndrome Definition 1999:Therapeutic Implications
Therapeutic Implications of Definition of Metabolic Syndrome
* If focus is on obesity as underlying cause
* Prevent and treat obesity
* If focus is on insulin resistance as underlying cause
* Treat insulin resistance
* If focus is on metabolic risk factors
* Treat individual risk factors
Criteria for Comparing Different Definitions of Metabolic Syndrome
Intensity of Therapy Should be Proportionate to Level of Risk
Cardiovascular Disease Mortality Increased in the Metabolic Syndrome:Kuopio Ischaemic Heart Disease Risk Factor Study
Cox Proportional Hazard Ratios (and 95% Confidence Intervals) Predicting All-Cause and Cardiovascular Mortality:San Antonio Heart Study 14-Year Follow-up
Comparison of NCEP and 1999 WHO Metabolic Syndrome to Identify Insulin-Resistant Subjects:IRAS
CRP Adds Prognostic Information at All Levels of Risk as Defined by the Framingham Risk Score
Partial Spearman Correlation Analysis of Inflammation Markers with Variables of IRS Adjusted for Age, Sex, Clinic, Ethnicity, and Smoking Status:IRAS
Mean Values of CRP by Number of Metabolic Disorders (Dyslipidemia, Upper Body Adiposity, Insulin Resistance, Hypertension):IRAS
Five-Year Incidence of Type 2 Diabetes Stratified by Quartiles of Inflammatory Proteins:IRAS
The Effect of Rosiglitazone on CRP
Summary
Does Lipid and Blood Pressure Therapy Work in Subjects with the Metabolic Syndrome?
* Diabetic subjects
* Blood pressure:YES
* Statin therapy:YES
* Nondiabetic subjects
* Little data available
"Metabolic Syndrome" in 4S
Efficacy of Multiple Risk Factor Intervention in High-Risk Subjects (Type 2 Diabetes with Microalbuminuria):Steno-2
Composite Endpoint of Death from CV Causes, Nonfatal MI, CABG, PCI, Nonfatal Stroke, Amputation, or Surgery for PAD:STENO-2
Summary:Metabolic Syndrome
* The metabolic syndrome predicts the development of both diabetes and CHD
* Insulin resistance and obesity characterize most individuals subjects with the metabolic syndrome, although not required features of the NCEP metabolic syndrome
* Initial therapy for the metabolic syndrome should consist of caloric restriction and increased physical activity
* Conventional cardiovascular risk factors such as lipids and blood pressure should be treated in individuals with the metabolic syndrome, although no recommendations have so far suggested intensification of risk factor management
* No consensus exists on whether insulin sensitizers should be used in nondiabetic individuals with the metabolic syndrome
Update on the Metabolic Syndrome
Steven Haffner, MD
Metabolic Syndrome Increases Risk for CHD and Type 2 Diabetes
High Risk of Impaired Glucose Tolerance and Type 2 Diabetes by OGTT in Post-MI Patients without Known Diabetes
Increased Metabolic Syndrome in Prediabetic Subjects: Baseline Risk Factors in Subjects with Normal Glucose Tolerance at Baseline according to Conversion Status at
8-Year Follow-up: San Antonio Heart Study
Elevated Risk of CVD Prior to Clinical Diagnosis of Type 2 Diabetes:
Nurses' Health Study
Risk of Major CHD Event Associated with Insulin Quintiles in Nondiabetic Subjects: Helsinki Policemen Study
CVD Risk Factors across HOMA-IR Quintiles:San Antonio Heart Study (Phase II)
Definitions of the Metabolic Syndrome
Definition of Metabolic Syndrome:
According to Underlying Causes
Therapeutic Implications:According to Underlying Causes
ATP III:The Metabolic Syndrome
Diagnosis is established when ?3 of these risk factors are present
Prevalence of the NCEP Metabolic Syndrome: NHANES III by Age
Prevalence of the NCEP Metabolic Syndrome:NHANES III by Sex and Race/Ethnicity
Prevalence of CHD by the Metabolic Syndrome and Diabetes in the NHANES Population Age 50+
ATP III Metabolic Syndrome:
Therapeutic Implications
Different Components of the NCEP Metabolic Syndrome Predict CHD:NHANES
Different Components of the NCEP Metabolic Syndrome Predict Diabetes:San Antonio Heart Study
WHO Metabolic Syndrome Definition 1999:Based on Clinical Criteria
Must Insulin Resistance be Present for a Patient to Have the Metabolic Syndrome?
WHO Metabolic Syndrome Definition 1999:Therapeutic Implications
Therapeutic Implications of Definition of Metabolic Syndrome
* If focus is on obesity as underlying cause
* Prevent and treat obesity
* If focus is on insulin resistance as underlying cause
* Treat insulin resistance
* If focus is on metabolic risk factors
* Treat individual risk factors
Criteria for Comparing Different Definitions of Metabolic Syndrome
Intensity of Therapy Should be Proportionate to Level of Risk
Cardiovascular Disease Mortality Increased in the Metabolic Syndrome:Kuopio Ischaemic Heart Disease Risk Factor Study
Cox Proportional Hazard Ratios (and 95% Confidence Intervals) Predicting All-Cause and Cardiovascular Mortality:San Antonio Heart Study 14-Year Follow-up
Comparison of NCEP and 1999 WHO Metabolic Syndrome to Identify Insulin-Resistant Subjects:IRAS
CRP Adds Prognostic Information at All Levels of Risk as Defined by the Framingham Risk Score
Partial Spearman Correlation Analysis of Inflammation Markers with Variables of IRS Adjusted for Age, Sex, Clinic, Ethnicity, and Smoking Status:IRAS
Mean Values of CRP by Number of Metabolic Disorders (Dyslipidemia, Upper Body Adiposity, Insulin Resistance, Hypertension):IRAS
Five-Year Incidence of Type 2 Diabetes Stratified by Quartiles of Inflammatory Proteins:IRAS
The Effect of Rosiglitazone on CRP
Summary
Does Lipid and Blood Pressure Therapy Work in Subjects with the Metabolic Syndrome?
* Diabetic subjects
* Blood pressure:YES
* Statin therapy:YES
* Nondiabetic subjects
* Little data available
"Metabolic Syndrome" in 4S
Efficacy of Multiple Risk Factor Intervention in High-Risk Subjects (Type 2 Diabetes with Microalbuminuria):Steno-2
Composite Endpoint of Death from CV Causes, Nonfatal MI, CABG, PCI, Nonfatal Stroke, Amputation, or Surgery for PAD:STENO-2
Summary:Metabolic Syndrome
* The metabolic syndrome predicts the development of both diabetes and CHD
* Insulin resistance and obesity characterize most individuals subjects with the metabolic syndrome, although not required features of the NCEP metabolic syndrome
* Initial therapy for the metabolic syndrome should consist of caloric restriction and increased physical activity
* Conventional cardiovascular risk factors such as lipids and blood pressure should be treated in individuals with the metabolic syndrome, although no recommendations have so far suggested intensification of risk factor management
* No consensus exists on whether insulin sensitizers should be used in nondiabetic individuals with the metabolic syndrome
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