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- September 9, 2010 |
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"Metabolic Syndrome and CHD Risk: Heterogeneity of Risk"Dr. Richard W. Nesto (biography)
English - 2004-11-08 - 46 minutes
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Summary :
In the U.S. there is a high prevalence of metabolic syndrome (1), and it is of interest to know which patients are at highest risk of cardiovascular disease (CVD), and what factors are driving the higher CVD risk associated with the metabolic syndrome.
In the Rancho Bernardo Study diabetes was found to be a stronger predictor of fatal coronary heart disease (CHD) in women than in men (2), and the WISE study showed that in women with coronary artery disease, those with the metabolic syndrome had as poor a survival rate as diabetic women (3). The poorer outcomes seen in diabetic women may be explained by various factors including a more atherogenic risk factor profile (4) and higher C-reactive protein levels (5).
The NHANES II study found that people having only one or two metabolic syndrome risk factors were still at substantial risk of CHD, suggesting that the current diagnostic criteria may be missing some high risk patients (6).
The NHANES III study showed that metabolic syndrome was strongly predictive of myocardial infarction and stroke, indicating the importance of insulin resistance as a risk factor for MI or stroke; within the factors of the metabolic syndrome, triglyceride (TG) and HDL cholesterol levels were the strongest correlates of CVD (7). With the current lack of a convenient laboratory test for insulin resistance, the plasma TG concentration or the TG:HDL ratio may be used to identify overweight patients who are insulin resistant (8).
Copyright © 2005 E-MedHosting.com Inc.
Learning objectives :
After viewing this presentation the participant will be able to discuss:
- The prevalence of metabolic syndrome in the U.S.
- The differential risk of CHD in diabetic men and women
- The risk of CHD according to the number and type of metabolic syndrome risk factors
- Plasma TG or TG:HDL ratio as indicators of insulin resistance in obese patients
Bibliographic references :
1. Earl S. Ford, MD,MPH; Wayne H. Giles, MD,MSc; William H. Dietz, MD,PhD. Prevalence of the Metabolic Syndrome Among US Adults: Findings From the Third National Health and Nutrition Examination Survey JAMA. 2002;287:356-359.
2. E. L. Barrett-Connor, B. A. Cohn, D. L. Wingard and S. L. Edelstein. Why is diabetes mellitus a stronger risk factor for fatal ischemic heart disease in women than in men? The Rancho Bernardo StudyJAMA. 1991;265:627-631.
3. Oscar C. Marroquin, MD; Kevin E. Kip, PhD; David E. Kelley, MD; B. Delia Johnson, PhD; Leslee J. Shaw, PhD; C. Noel Bairey Merz, MD; Barry L. Sharaf, MD; Carl J. Pepine, MD; George Sopko, MD; Steven E. Reis, MD, for the Women’s Ischemia Syndrome Evaluation Investigators Metabolic Syndrome Modifies the Cardiovascular Risk Associated With Angiographic Coronary Artery Disease in Women: A Report From the Women’s Ischemia Syndrome Evaluation Circulation. 2004;109:714-721.
4. BV Howard, LD Cowan, O Go, TK Welty, DC Robbins and ET Lee.
Adverse effects of diabetes on multiple cardiovascular disease risk factors in women. The Strong Heart StudyDiabetes Care. 1998; Vol 21, Issue 8:1258-1265.
5. Martin K. Rutter, MD; James B. Meigs, MD, MPH; Lisa M. Sullivan, PhD; Ralph B. D’Agostino, Sr, PhD; Peter W.F. Wilson, MD C-Reactive Protein, the Metabolic Syndrome, and Prediction of Cardiovascular Events in the Framingham Offspring Study Circulation. 2004;110:380-385.
6. Shaista Malik, MD, MPH; Nathan D. Wong, PhD, MPH; Stanley S. Franklin, MD; Tripthi V. Kamath, PhD; Gilbert J. L’Italien, PhD; Jose R. Pio, BS; G. Rhys Williams, ScD. Impact of the Metabolic Syndrome on Mortality From Coronary Heart Disease, Cardiovascular Disease, and All Causes in United States Adults Circulation. 2004;110:1245-1250.
7. John K. Ninomiya, MSc; Gilbert L’Italien, PhD; Michael H. Criqui, MD, MPH; Joanna L. Whyte, MS, RD, MSPH; Anthony Gamst, PhD; Roland S. Chen, MD Association of the Metabolic Syndrome With History of Myocardial Infarction and Stroke in the Third National Health and Nutrition Examination Survey Circulation. 2004;109:42-46.
8. Tracey McLaughlin, MD; Fahim Abbasi, MD; Karen Cheal, MPH; James Chu, MD; Cindy Lamendola, MSN; and Gerald Reaven, MD. Use of Metabolic Markers To Identify Overweight Individuals Who Are Insulin ResistantAnn Int Med. 2003;139(10):802-809.
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