Sndrome metablico

y prevencin de enfermedad cardiovascular Josep Vidal Hospital Clnic Universitari Barcelona(un diagnstico en crisis)

1923 Kylin Asociacin hipertensin, hiperglucemia, hiperuricemia

Sndrome metablico

1923 Kylin Asociacin hipertensin, hiperglucemia, hiperuricemia1955 VagueObesidad central ms elementos RCV que perifricaSndrome metablico

1923 Kylin Asociacin hipertensin, hiperglucemia, hiperuricemia1955 VagueObesidad central ms elementos RCV que perifrica1980 ReavenSndrome X: resistencia a la insulina, alteracin tolerancia a la glucosa, hipertrigliceridemia, colesterol HDL bajo, hipertensin Sndrome metablico

1923 Kylin Asociacin hipertensin, hiperglucemia, hiperuricemia1955 VagueObesidad central ms elementos RCV que perifrica1980 ReavenSndrome X: resistencia a la insulina, alteracin tolerancia a la glucosa, hipertrigliceridemia, colesterol HDL bajo, hipertensin 1980-1999Distintos elementos aadidos al conceptoCambios cualitativos lpidos, disfuncin endotelial, estado procoagulante, inflamacin

Sndrome metablico

1923 Kylin Asociacin hipertensin, hiperglucemia, hiperuricemia1955 VagueObesidad central ms elementos RCV que perifrica1980 ReavenSndrome X: resistencia a la insulina, alteracin tolerancia a la glucosa, hipertrigliceridemia, colesterol HDL bajo, hipertensin 1980-1999Distintos elementos aadidos al conceptoCambios cualitativos lpidos, disfuncin endotelial, estado procoagulante, inflamacin 1999-actualDefiniciones de SM OMS, ATPIII, EGIR, ACE, IDFSndrome metablico

Tres o ms de los siguientes:Obesidad abdominalCintura > 102 cm en hombresCintura > 88 cm en mujeresGlucemia plasmtica en ayunas > 110 mg/dlTensin arterial > 130 / 85 mmHgTriglicridos > 150 mg/dlHDL-colesterol < 40 mg/dl en hombres< 50 mg/dl en mujeresDefinicinNCEP (2001)

Tres o ms de los siguientes:Obesidad abdominalCintura > 102 cm en hombresCintura > 88 cm en mujeresGlucemia plasmtica en ayunas > 100 mg/dl o ttoTensin arterial > 130/85 mmHg o ttoTriglicridos > 150 mg/dl o tto*HDL-colesterol < 40 mg/dl en hombres< 50 mg/dl en mujeres* Fibrato o Ac nicotnicoDefinicinNCEP (2005)

Sndrome metablicoConceptoGlucemiaelevadaLDL-CelevadoHDL-CbajoTriglic.elevadosTASelevadaEdadTabacoSexo MH fam +Enfermedad cardiovascularObesidad centralMejora sincrnica FRCV con cambios en estilo de vida

La prevalencia de SM segn criterios utilizadosEdad (aos)Adams S. Diabetes Care 2005VaronesMujeresEstados Unidos

Sndrome metablicoEl problemaLDL-CelevadoEdadTabacoSexo MH fam +Enfermedad cardiovascularSndrome metablicoOlvida otros marcadores de acuerdo con base fisiopatolgicaSu valor como diagnstico sobrepasa al concepto

En contra:A favor:The Metabolic Syndrome Still LivesGrundy, Clin Chemistry 2005The Metab. Syndrome: Riquescat in PaceReaven, Clin Chemistry 2005

Sndrome metablicoRelacin con enfermedad cardiovascularEnfermedad cardiovascularSndrome metablicoPrevencin 1aria En ausencia DM 2 En presencia DM 2Prevencin 2aria

Hoorn Studyn=615 H y 749 mujeres, no DM ni ECV en 1989-90Relacin: SM NCEP-ATPIIIEventos CV ocurridos antes de 1-1-200Dekker JM, Circulation 2005HombresMujeresPrevencin 1aria

Hoorn StudySM y tipo de eventosDekker JM, Circulation 2005HombresMujeresPrevencin 1aria

Estudio Botnia Prevalencia Enf coronaria segn tolerancia a glucosa

Si SMNo SMIsomaa B et al. Diabetes Care. 2001.N=3928N=1808N=685N=1430Criterios OMSPrevencin 1aria

Assmann G. End Metab Clin N Am 2004

Estudio PROCAM Importancia de la concurrencia de FRCV (n= 19.700, mediana edad)TATAHDLTg Tg HDLCriterios ATPIII modificadosPrevencin 1aria

GISSI Prevenzione Trialn=11.323 pacientes, IAM

Poblacin austracan=750, coronarogria por EC establecida o sospechaSeguimiento 2,3 0,4 aosSaely, J Clin Endocrinol Metab 2005Prevencin 2ariaSM noSM siRiesgo relativo por SMCriterios ATPIII

Sndrome metablicoRelacin con enfermedad cardiovascularEnfermedad cardiovascularSndrome metablicoPrevencin 1aria En ausencia DM 2 En presencia DM 2Prevencin 2aria

Sndrome metablicoRelacin con enfermedad cardiovascularEnfermedad cardiovascularSndrome metablicoPrevencin 1aria En ausencia DM 2 En presencia DM 2Prevencin 2ariaDM >SMEstudio HOORN Dekker JM, Circulation 2005

Sndrome metablicoRelacin con enfermedad cardiovascularEnfermedad cardiovascularSndrome metablicoPrevencin 1aria En ausencia DM 2 En presencia DM 2Prevencin 2ariaDMPrevencin 2ariaSMno DM/noSMEstudio WISEMarroquin, Circulation 2004 DM >SMDM >SM

Sndrome metablicoRelacin con enfermedad cardiovascularEnfermedad cardiovascularSndrome metablicoPrevencin 1aria En ausencia DM 2 En presencia DM 2Prevencin 2ariaOlvida otros marcadores de acuerdo con base fisiopatolgicaSu valor como diagnstico sobrepasa al conceptoMejor prediccin ECV que con ecuacin Framingham?Protena C reactivaProblemas

Efecto valorar PCR sobre la relacin SM-ECV (Prevencin 1aria)Ridker PM. Circulation, June 04

Stern MP, Diabetes Care 2004SensibilidadFalsos positivosSd. Metablico

San Antonio Heart Study, n= 2570, follow up 7.5 y67,3%34,2%Framinghamfijado a 34,2%Framinghamfijado a 67,3%20,0%81,4%Mejor prediccin ECV que con ecuacin Framingham?

Tratamiento

Tratamiento Sd. Metablico

GlucemiaelevadaLDL-CelevadoHDL-CbajoTriglic.elevadosTASelevadaEdadTabacoSexo MH fam +Enfermedad cardiovascularObesidad centralMejora sincrnica FRCV con cambios en estilo de vida

Tratamiento Sd. Metablico

Sndrome metablicoGlucemiaelevadaLDL-CelevadoHDL-CbajoTriglic.elevadosTASelevadaEdadTabacoSexo MH fam +Enfermedad cardiovascularObesidad central Mejora sincrnica FRCV con cambios en estilo de vida

Estilo de vida y Sd. MetablicoDiabetes Prevention ProgramSujetos con TDG, 3 aos seguimiento

DPP Study Group, Ann Int Med 2005 Estilo de vida y Sd. MetablicoDiabetes Prevention Program

Resolucin SM por grupo tto P

Seales perifricasLeptinaInsulinaIngestaGasto energticoBalanceEnergticoSibutraminaOrlistatFrmacos tratamiento obesidad Seales centralesRimonabant

- 60- 50- 40- 30- 20- 100- 21%- 53%p

Tratamiento Sd. Metablico

Sndrome metablicoGlucemiaelevadaLDL-CelevadoHDL-CbajoTriglic.elevadosTASelevadaEdadTabacoSexo MH fam +Enfermedad cardiovascularObesidad

Tratamiento Sd. Metablico Los problemasLDL-CelevadoEdadTabacoSexo MH fam +Enfermedad cardiovascularSndrome metablicoPudiera obviarse cambio EV en quien tambin precisaPuede llevar a no tratar adecuadamente FRCV muy importantesLos cambios en EV no eran ya parte del tratamiento de FRCV?

Recomendaciones AHA 05Sndrome metablicoObjetivos de tto segn riesgo calculadoTabacoThe metabolic syndrome: Modify root causes, Treat risk factors

Tratamiento

Tratamiento

Tratamiento+ otros FRCV

Tratamiento Sd. Metablico Los problemasParecera que hay margen para mejorar la tasa de recomendaciones sobre cambios en EV

El concepto de Sd. Metablico es til para la identificacin de pacientes con riesgo CV y para subrayar la importancia del estilo de vida (especialmente en relacin con la obesidad central) en la prevencin y tratamiento de la ECVResumen

A pesar de ello no debe sobrevalorarse el diagnstico:

Es necesaria una mejor definicin del SM Equilibrando facilidad en el diagnstico con utilidad clnica No debe considerarse un equivalente de ECV ni sustituir a otras escalas de estimacin de RCV No debe hacernos olvidar de que el tratamiento farmacolgico de los FRCV establecidos es una prioridad.Resumen

Gracias por su atencin

Metabolic syndrome increases risk for CHD and type 2 diabetesThe National Cholesterol Education Program (NCEP) has traditionally focused on high low-density lipoprotein cholesterol (LDL-C) as a risk factor for coronary heart disease (CHD). In the NCEP Adult Treatment Panel III (ATP III) recommendations published in JAMA in 2001, the NCEP suggested that the metabolic syndrome might independently predict the development of both type 2 diabetes and CHD. Note that in most definitions of the metabolic syndrome whether NCEP, WHO or AACE, diabetic subjects are included among those subjects who now have the metabolic syndrome. Most papers examining the relationship of the metabolic syndrome to cardiovascular disease have excluded diabetic subjects with the metabolic syndrome since diabetic subjects are at high risk of cardiovascular disease whether they have the metabolic syndrome or not. Note also that the arrow pointing from the metabolic syndrome to type 2 diabetes refers to non-diabetic metabolic syndrome patients.

References:Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of the third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA 2001;285:2486-2497.

Rexrode KM, Carey VJ, Hennekens CH et al. Abdominal adiposity and coronary heart disease in women. JAMA 1998;280:1843-8.

Metabolic syndrome increases risk for CHD and type 2 diabetesThe National Cholesterol Education Program (NCEP) has traditionally focused on high low-density lipoprotein cholesterol (LDL-C) as a risk factor for coronary heart disease (CHD). In the NCEP Adult Treatment Panel III (ATP III) recommendations published in JAMA in 2001, the NCEP suggested that the metabolic syndrome might independently predict the development of both type 2 diabetes and CHD. Note that in most definitions of the metabolic syndrome whether NCEP, WHO or AACE, diabetic subjects are included among those subjects who now have the metabolic syndrome. Most papers examining the relationship of the metabolic syndrome to cardiovascular disease have excluded diabetic subjects with the metabolic syndrome since diabetic subjects are at high risk of cardiovascular disease whether they have the metabolic syndrome or not. Note also that the arrow pointing from the metabolic syndrome to type 2 diabetes refers to non-diabetic metabolic syndrome patients.

References:Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of the third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA 2001;285:2486-2497.Metabolic syndrome increases risk for CHD and type 2 diabetesThe National Cholesterol Education Program (NCEP) has traditionally focused on high low-density lipoprotein cholesterol (LDL-C) as a risk factor for coronary heart disease (CHD). In the NCEP Adult Treatment Panel III (ATP III) recommendations published in JAMA in 2001, the NCEP suggested that the metabolic syndrome might independently predict the development of both type 2 diabetes and CHD. Note that in most definitions of the metabolic syndrome whether NCEP, WHO or AACE, diabetic subjects are included among those subjects who now have the metabolic syndrome. Most papers examining the relationship of the metabolic syndrome to cardiovascular disease have excluded diabetic subjects with the metabolic syndrome since diabetic subjects are at high risk of cardiovascular disease whether they have the metabolic syndrome or not. Note also that the arrow pointing from the metabolic syndrome to type 2 diabetes refers to non-diabetic metabolic syndrome patients.

References:Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of the third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA 2001;285:2486-2497.Risk factors occur in isolation only 30% of the time, and clustering of three or more factors occurs 17% of the time in both genders

Risk factors occur in isolation only 30% of the time, and clustering of three or more factors occurs 17% of the time in both genders

Metabolic syndrome increases risk for CHD and type 2 diabetesThe National Cholesterol Education Program (NCEP) has traditionally focused on high low-density lipoprotein cholesterol (LDL-C) as a risk factor for coronary heart disease (CHD). In the NCEP Adult Treatment Panel III (ATP III) recommendations published in JAMA in 2001, the NCEP suggested that the metabolic syndrome might independently predict the development of both type 2 diabetes and CHD. Note that in most definitions of the metabolic syndrome whether NCEP, WHO or AACE, diabetic subjects are included among those subjects who now have the metabolic syndrome. Most papers examining the relationship of the metabolic syndrome to cardiovascular disease have excluded diabetic subjects with the metabolic syndrome since diabetic subjects are at high risk of cardiovascular disease whether they have the metabolic syndrome or not. Note also that the arrow pointing from the metabolic syndrome to type 2 diabetes refers to non-diabetic metabolic syndrome patients.

References:Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of the third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA 2001;285:2486-2497.Metabolic syndrome increases risk for CHD and type 2 diabetesThe National Cholesterol Education Program (NCEP) has traditionally focused on high low-density lipoprotein cholesterol (LDL-C) as a risk factor for coronary heart disease (CHD). In the NCEP Adult Treatment Panel III (ATP III) recommendations published in JAMA in 2001, the NCEP suggested that the metabolic syndrome might independently predict the development of both type 2 diabetes and CHD. Note that in most definitions of the metabolic syndrome whether NCEP, WHO or AACE, diabetic subjects are included among those subjects who now have the metabolic syndrome. Most papers examining the relationship of the metabolic syndrome to cardiovascular disease have excluded diabetic subjects with the metabolic syndrome since diabetic subjects are at high risk of cardiovascular disease whether they have the metabolic syndrome or not. Note also that the arrow pointing from the metabolic syndrome to type 2 diabetes refers to non-diabetic metabolic syndrome patients.

References:Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of the third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA 2001;285:2486-2497.Metabolic syndrome increases risk for CHD and type 2 diabetesThe National Cholesterol Education Program (NCEP) has traditionally focused on high low-density lipoprotein cholesterol (LDL-C) as a risk factor for coronary heart disease (CHD). In the NCEP Adult Treatment Panel III (ATP III) recommendations published in JAMA in 2001, the NCEP suggested that the metabolic syndrome might independently predict the development of both type 2 diabetes and CHD. Note that in most definitions of the metabolic syndrome whether NCEP, WHO or AACE, diabetic subjects are included among those subjects who now have the metabolic syndrome. Most papers examining the relationship of the metabolic syndrome to cardiovascular disease have excluded diabetic subjects with the metabolic syndrome since diabetic subjects are at high risk of cardiovascular disease whether they have the metabolic syndrome or not. Note also that the arrow pointing from the metabolic syndrome to type 2 diabetes refers to non-diabetic metabolic syndrome patients.

References:Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of the third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA 2001;285:2486-2497.Metabolic syndrome increases risk for CHD and type 2 diabetesThe National Cholesterol Education Program (NCEP) has traditionally focused on high low-density lipoprotein cholesterol (LDL-C) as a risk factor for coronary heart disease (CHD). In the NCEP Adult Treatment Panel III (ATP III) recommendations published in JAMA in 2001, the NCEP suggested that the metabolic syndrome might independently predict the development of both type 2 diabetes and CHD. Note that in most definitions of the metabolic syndrome whether NCEP, WHO or AACE, diabetic subjects are included among those subjects who now have the metabolic syndrome. Most papers examining the relationship of the metabolic syndrome to cardiovascular disease have excluded diabetic subjects with the metabolic syndrome since diabetic subjects are at high risk of cardiovascular disease whether they have the metabolic syndrome or not. Note also that the arrow pointing from the metabolic syndrome to type 2 diabetes refers to non-diabetic metabolic syndrome patients.

References:Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of the third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA 2001;285:2486-2497.Metabolic syndrome increases risk for CHD and type 2 diabetesThe National Cholesterol Education Program (NCEP) has traditionally focused on high low-density lipoprotein cholesterol (LDL-C) as a risk factor for coronary heart disease (CHD). In the NCEP Adult Treatment Panel III (ATP III) recommendations published in JAMA in 2001, the NCEP suggested that the metabolic syndrome might independently predict the development of both type 2 diabetes and CHD. Note that in most definitions of the metabolic syndrome whether NCEP, WHO or AACE, diabetic subjects are included among those subjects who now have the metabolic syndrome. Most papers examining the relationship of the metabolic syndrome to cardiovascular disease have excluded diabetic subjects with the metabolic syndrome since diabetic subjects are at high risk of cardiovascular disease whether they have the metabolic syndrome or not. Note also that the arrow pointing from the metabolic syndrome to type 2 diabetes refers to non-diabetic metabolic syndrome patients.

References:Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of the third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA 2001;285:2486-2497.Metabolic syndrome increases risk for CHD and type 2 diabetesThe National Cholesterol Education Program (NCEP) has traditionally focused on high low-density lipoprotein cholesterol (LDL-C) as a risk factor for coronary heart disease (CHD). In the NCEP Adult Treatment Panel III (ATP III) recommendations published in JAMA in 2001, the NCEP suggested that the metabolic syndrome might independently predict the development of both type 2 diabetes and CHD. Note that in most definitions of the metabolic syndrome whether NCEP, WHO or AACE, diabetic subjects are included among those subjects who now have the metabolic syndrome. Most papers examining the relationship of the metabolic syndrome to cardiovascular disease have excluded diabetic subjects with the metabolic syndrome since diabetic subjects are at high risk of cardiovascular disease whether they have the metabolic syndrome or not. Note also that the arrow pointing from the metabolic syndrome to type 2 diabetes refers to non-diabetic metabolic syndrome patients.

References:Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of the third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA 2001;285:2486-2497.Metabolic syndrome increases risk for CHD and type 2 diabetesThe National Cholesterol Education Program (NCEP) has traditionally focused on high low-density lipoprotein cholesterol (LDL-C) as a risk factor for coronary heart disease (CHD). In the NCEP Adult Treatment Panel III (ATP III) recommendations published in JAMA in 2001, the NCEP suggested that the metabolic syndrome might independently predict the development of both type 2 diabetes and CHD. Note that in most definitions of the metabolic syndrome whether NCEP, WHO or AACE, diabetic subjects are included among those subjects who now have the metabolic syndrome. Most papers examining the relationship of the metabolic syndrome to cardiovascular disease have excluded diabetic subjects with the metabolic syndrome since diabetic subjects are at high risk of cardiovascular disease whether they have the metabolic syndrome or not. Note also that the arrow pointing from the metabolic syndrome to type 2 diabetes refers to non-diabetic metabolic syndrome patients.

References:Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of the third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA 2001;285:2486-2497.Metabolic syndrome increases risk for CHD and type 2 diabetesThe National Cholesterol Education Program (NCEP) has traditionally focused on high low-density lipoprotein cholesterol (LDL-C) as a risk factor for coronary heart disease (CHD). In the NCEP Adult Treatment Panel III (ATP III) recommendations published in JAMA in 2001, the NCEP suggested that the metabolic syndrome might independently predict the development of both type 2 diabetes and CHD. Note that in most definitions of the metabolic syndrome whether NCEP, WHO or AACE, diabetic subjects are included among those subjects who now have the metabolic syndrome. Most papers examining the relationship of the metabolic syndrome to cardiovascular disease have excluded diabetic subjects with the metabolic syndrome since diabetic subjects are at high risk of cardiovascular disease whether they have the metabolic syndrome or not. Note also that the arrow pointing from the metabolic syndrome to type 2 diabetes refers to non-diabetic metabolic syndrome patients.

References:Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of the third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA 2001;285:2486-2497.Metabolic syndrome increases risk for CHD and type 2 diabetesThe National Cholesterol Education Program (NCEP) has traditionally focused on high low-density lipoprotein cholesterol (LDL-C) as a risk factor for coronary heart disease (CHD). In the NCEP Adult Treatment Panel III (ATP III) recommendations published in JAMA in 2001, the NCEP suggested that the metabolic syndrome might independently predict the development of both type 2 diabetes and CHD. Note that in most definitions of the metabolic syndrome whether NCEP, WHO or AACE, diabetic subjects are included among those subjects who now have the metabolic syndrome. Most papers examining the relationship of the metabolic syndrome to cardiovascular disease have excluded diabetic subjects with the metabolic syndrome since diabetic subjects are at high risk of cardiovascular disease whether they have the metabolic syndrome or not. Note also that the arrow pointing from the metabolic syndrome to type 2 diabetes refers to non-diabetic metabolic syndrome patients.

References:Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of the third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA 2001;285:2486-2497.