代谢综合症预防心脏病的前景

MetabolicSyndrome:

APerspectiveinPreventiveCardiology

FocusesofCurrentDebatesinMetabolicSyndrome

Definitions??????Etiologyandpathophysiology??????

Clinicalimportance???????

ImportanceforCVDprevention???????ClinicalPerspectivesforMS●

WhoaretheMSpatients??(Diagnosticissue)●

WhoneedtheclinicaltreatmentamongtheMSpatientsand??●

HowtotreattheMSpatients??(Treatmentissue)●

Theeffectivenessoftreatmentstrategies??(Treatmentissue)TheProportionofMSbyDifferentCriteriaforCentralObesityMaleFemale

TreatmentDecisioninMS

HypertensionHighBPHighTGDiabetesIFGCentralObesityLowHDL-CWhoneedstreatmentasMSpatients?WhatarethespecifictargetsoftreatmentforMSpatients?PreventivePerspectives

forMS

●

IfthemajorcomponentsofMShavecommonpathophysiologicalpathway???●

IfMShasuniquevalueinpredictionofCVD???●

HowtopreventMS??

IfthecomponentsinMShavecommonpathophysiologicalpathway???

Humanobesity……isduetoanexcessproductionoffreefattyacidsfromtheselipolyticallyactivedepots.This,inturn,mightcausehyperinsulinemiaviareducedhepaticinsulinuptake,followedbyperipheralhyper-insulinemia,insulinresistanceand,perhaps,diabetesmellitusandhypertension.BjorntorpPJClinHypertension19862:163

…….ThesedatastronglysupporttheviewthatinsulinplayanimportantroleinregulationofHDLmetabolism.GolayAJLipidRes198728:10-18

AtheroscleroticCVDIGTType2DMdyslipidemiaFFA

TGHDL-C

BP

Insulinresistance

BantingLecture:ReavenGM1988Diabetes37:1595Hyperinsulinaemia%ThePrevalenceofHyperinsulinaemiabyIncreasingNumbersofComponentsinMetabolic

Syndrome

(CMCSStudy,2002)%PercentagesofOnlyOneComponentofMetabolicSyndromeinPeoplewithandwithoutHyperinsulinaemia

HTG

HypertensionLowHDLHighGlucose

(CMCSStudy,2002)HyperinsulinaemiaInsulinnormal不同FFA和胰岛素抵抗水平时

各种代谢综合征组份异常的患病率（%）腹部肥胖高TG血症低HDL-C血症高血糖高血压不同FFA和胰岛素抵抗水平时

代谢综合征的患病率（%）代谢综合征患病率%FFA四分位分层胰岛素抵抗四分位分层腹部肥胖高TG血症低HDL-C血症高血糖高血压FFAⅠ─────

Ⅱ2.02.8NS1.51.7

Ⅲ1.72.4NS2.12.1Ⅳ2.13.9NS3.72.7HOMA_IR

Ⅰ─────

Ⅱ1.52.41.62.8NS

Ⅲ2.53.81.95.4NS

Ⅳ2.17.03.428.9NS调整年龄、性别、吸烟、饮酒、BMI、胰岛素抵抗指数/FFANS：无统计学显著性，未进入方程各种代谢综合征组份异常的

多因素Logistic回归分析OR值OR95%CIFFAⅠ──

Ⅱ3.1（1.9-5.2）

Ⅲ3.1（1.9-5.1）Ⅳ4.1（2.5-6.7）HOMA_IR

Ⅰ──

Ⅱ1.8（1.1-3.0）

Ⅲ2.4（1.4-3.9）

Ⅳ7.0（4.2-11.8）调整年龄、性别、吸烟、饮酒、BMI、胰岛素抵抗指数/FFAFFA与胰岛素抵抗和代谢综合征关系的

多因素Logistic回归分析OR值

IfMShasuniquevalueinpredictionofCVD???StudiesoftheAssociationbetweenMSandAll-causeMortalityAuthorYearOfPublishStudySamplesizeFollow-up(years)Lakka2002

KuopioIschaemicHeartDiseaseRiskFactorStudy,Finland120911.4Katzmarzyk

2004

AerobicsCenterLongitudinalStudy1922310.2Hunt2004

SanAntonioHeartStudy281512.7

Ford2004

NationalHealthandNutritionExaminationSurveyIIMortalityStudy243113.5

AuthorYearofpublishStudySamplesizeFollow-up(years)Onat2002

TurkishAdultRiskFactorStudy,Turkey23983Lakka2002

KuopioIschemicHeartDiseaseRiskFactorStudy,Finland120911.4Resnick2003

StrongHeartStudy22837.6Katzmarzyk2004

AerobicsCenterLongitudinalStudy1922310.2Bonora2004

BruneckStudy,Italy8885

Rutter2004

FraminghamOffspringStudy30376.9StudiesoftheAssociationbetweenMSandCVD

AuthorYearStudySamplesizeFollow-up(years)McNeill2005AtherosclerosisRiskinCommunitiesStudy12,08911

Hunt2004SanAntonioHeartStudy12,08912.7

Ridker2003Women’sHealthStudy14,7198Sattar2003WestofScotlandCoronaryPreventionStudy,U.K.6,4474.9Girman2004AirForce/TexasCoronaryAtherosclerosisPreventionStudy3,1885Ford2004NationalHealthandNutritionExaminationSurveyIIMortalityStudy2,43113.5StudiesoftheAssociationbetweenMSandCVD

AuthorYearStudySamplesizeFollow-up(years)

Laaksonen2002KuopioIschemicHeartDiseaseRiskFactorStudy,Finland9584

Resnick2003StrongHeartStudy22837.6Sattar2003WestofScotlandCoronaryPreventionStudy,U.K.59474.9Lorenzo2003SanAntonioHeartStudy17347–8

Stern2004MexicoCityDiabetesStudy,Mexico13536.3StudiesoftheAssociationbetweenMSandDiabetes

IfMShasuniquevalueinpredictionofCVD???

MS(ATPIII)andAll-causeDeathMS(ATPIII)andCVDMS(ModifiedATPIII)andCVDMS(ATPIII*)andCVD

HowtopreventMS??Allproposedhealthprojectgoalsaredevelopedandformulatedfromahealth

determinant

perspective.

ExperiencesfromSweden：DeterminantsofHealthByfullyimplementingthePlan,wecan:

preventthecausesofheartdiseaseandstroke–nolongerwaitingtotreatthecausesortheirconsequences,whenthecausesthemselvescanbepreventedinthefirstplace.

ComponentsinCVDPreventionandControlDietsTobaccoalcoholExerciseHealthEnvironments

CADBloodPressure

HypertensionLipidsDyslipidemia

GlucoseDiabetesWeightObesityStrokePeripheralarterialsdiseasesDeathDisabilityUpstreamMidstreamDownstreamPreventionTreatment

MajorcardiacproceduresInChina(casenumbers)

1973-95

Upto2002PTCA2000180000CABG100075000CoronaryStenting3073300Awareness,treatment&controlrateofhypertensionInChina(2001)

DFGuetal.TsungO.Cheng.Hypertension200240:920Inter.JCardiology2004

96:425

Thecomparisonofpercapitatotalexpenditureonhealthbetweenhighincomecountriesandlow&middleincomecountries

AdaptedfromWHOWorldHealth