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Click to edit Master title style,Click to edit Master text styles,Second level,Third level,*,The Metabolic Syndrome:,Ready for Prime Time in Clinical Settings?,Yuling Hong,MD,PhD,FAHA*,Director,Biostatistics and Epidemiology,Senior Science and Medicine Advisor,American Heart Association,The presentation does not necessarily represent the,official position of the American Heart Association,Outline,Evolution of the the Metabolic Syndrome(MetS).,Clinical definitions and the implications.,Major health consequences of the MetS.,Is the metabolic syndrome a useful marker of CHD above and beyond the risk associated with its individual components and other major CVD risk factors,?,Underlying mechanisms behind the MetS and,factors associated with it.,Management of the MetS?,Future research directions,The Metabolic Syndrome,also referred to as Syndrome X,Syndrome X Plus,the Insulin Resistance Syndrome,Diabesity,the Big 4,the Deadly Quartet,the,the Reaven Syndrome,is a term for constellation of endogenous risk factors that increase the risk of developing both atherosclerostic vascular disease(ASCVD)and type 2 diabetes mellitus.,What is the MetS,1923:Kylin described clustering of hypertension,gout,and hyperglycemia,1988:Reavens Banting lecture at ADA Annual Conference described the term of Syndrome X.,1998:World Health Organization first defined the MetS for clinicians and researchers.,2001:US NCEP ATP III definition for the,MetS,was released,2005:IDF and AHA/NHLBI definition of the,MetS,for worldwide use was released,Evolution of the MetS,Major abnormalities for Syndrome X in Dr.Reaven 1988 Banting Lecture,1.Hypertension,2.Hyperglycemia,3.Glucose intolerance,4.Elevated serum triglycerides,5.Low serum HDL cholesterol,Obesity was included and no cut-off,points for these abnormalities.,Proposed MetS Definitions,WHO(1998),Insulin resistance,DM/IGT/IFG,2 or more of,1)Obesity,W/H ratio:0.9(m),0.85(w);BMI:30,2)Dyslipidemia,TG,150;,HDL-c,35(m)/39(w),3)Blood pressure,140/90,4)High glucose,5)Microalbuminura,EGIR(1999),Insulin resistance,2 or more of,1)Obesity,WC:,94(m)/80(w),2)Dyslipidemia,TG,150;,HDL-c,39,3)Blood pressure,140/90 or RX,4)High glucose,IGT or IFG(but not,DM),ATP III(2001),3 or more of,1)Obesity,WC,102(m)/88(w),2)High TG,150,3)Low HDL-C,110 including DM,Proposed MetS Definitions,AACE(2003),IGT/IFG,1 or more of,1)Obesity,BMI:30,2)Dyslipidemia,TG,150;,HDL-c,40(m)/45(w),3)Blood pressure,130/85,4)High glucose,5)Other features of,Insulin resistance,IDF(2005),Increase WC,(population specific),2 or more of,1)TG,150 or Rx,2)HDL-c,40(m)/50(w)or RX,3)Blood pressure,130(S)or 85(D),or Rx,4)High glucose,100 including DM,AHA/NHLBI,(2005),3 or more of,1)Obesity,WC,102(m)/88(w)*,2)High TG,150 or Rx,3)Low HDL-C,100 or Rx,*90/80 for Asician A,Prevalence of Components of the MetS*,Abdominal obesity39%,Hypertriglyceridemia30%,Low HDL cholesterol37%,High blood pressure or medication use34%,High fasting glucose or medication use13%,1 Metabolic Abnormalities:71%,2 Metabolic Abnormalities:44%,3 Metabolic Abnormalities:24%,47 MM US Residents,*,US adults age 20 and over(1988-1994),Ford ES,et al.,JAMA,.2002:287:356-359.,Age-Adjusted Prevalence of the MetS:Results from the NHANES III Survey*,*,Criteria based on ATP III;diabetics were included in diagnosis;overall unadjusted prevalence was 21.8%.,Prevalence,%,24.8,16.4,28.3,22.8,25.7,35.6,0,5,10,15,20,25,30,35,40,White,25.7%,difference,African American,Mexican American,Men,Women,56.7%difference,Ford ES,et al.JAMA.2002;287:356-359.,0,5,10,15,20,25,30,35,40,45,50,20-70+,20-29,30-39,40-49,50-59,60-69,70,Men,Women,Increasing Prevalence of NCEP,MetS with Age(NHANES III),Age(years),Ford E et al.JAMA.2002;287:356,(%),Number of publication of the MetS,in Medical Literatures,Year of publication,Number of Publications,Anyway in the Citation,In the title only,1970,70,13,1980,79,30,1988,203,84,1990,260,91,1995,649,278,2000,1097,466,2004,2381,1180,How is the MetS used by clinicians?,On May 11,2000,The US ICD-9-CM,Coordinating and Maintenance Committee,created a new ICD code for the MetS.,The official name is Dysmetabolic Syndrome,In October 2001,the code of,277.7,became available.,How is the MetS is used by clinicians?,Sixteen,and,11,records of the MetS in the 2002 and,2003 NHDS database(327254 and 319530 records),Of 16 records in 2002,3:third-listed Dx,2 each:fourth-and fifth-listed,Dx,6:sixth-listed Dx,3:seventh-listed Dx,Of 11 records in 2003,1:First-listed Dx,2 each:third-through seventh-listed Dx,Ford E.Diabetes Care,2005;28:1808,Major Health Consequences of the MetS,Summary of evidence from 15 prospective studies,Relative Risk for,ATP III MetS definition,For all-cause mortality,1.27,(95%CI:0.90-1.78),For CVD,1.65,(95%CI:1.38-1.99),For DM,2.99,(95%CI:1.96-4.57),Relative Risk for WHO,MetS definition,For all-cause mortality,1.37,(95%CI:1.09-1.74),For CVD,1.93,(95%CI:1.39-2.67),For DM,2.60,(95%CI:1.55-4.38),Ford E.Diabetes Care 2005;28:1769,Major Health Consequences of the MetS,Summary of evidence from 1
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