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Metabolic Syndrome Diabetes and CVD CCL 052110 FINAL

Metabolic Syndrome Diabetes and CVD CCL 052110 FINAL -...

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Cardiovascular Disease and the Patient with Diabetes and Metabolic Syndrome Nathan D. Wong, PhD, FACC, FAHA Professor and Director Heart Disease Prevention Program Division of Cardiology University of California, Irvine President, American Society for Preventive Cardiology
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Presenter Disclosure Dr. Wong has received research support through Bristol-Myers Squibb, Novartis, and Forest Laboratories through the University of California, Irvine
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Presentation Objectives Review the epidemiology implicating metabolic syndrome and diabetes in cardiovascular risk Discuss the clinical trial evidence for the role of lifestyle management, glycemic, lipid, and blood pressure control. Address the ABCs of lifestyle and clinical management of metabolic syndrome and diabetes aimed to reduce cardiovascular disease risk.
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Diagnosed Diabetes in the US: 2008 http://apps.nccd.cdc.gov/brfss/list.asp?cat=DB&yr=2008&qkey=1363&state=All 4 – 6% 6 – 8% 8 – 10% 10 – 12% CDC BRFSS: Self-Reported Diabetes: 8.2% Nationwide
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Prevalence of physician-diagnosed diabetes in Adults age 20 Prevalence of physician-diagnosed diabetes in Adults age 20 and older by race/ethnicity and sex (NHANES: 2005-2006). and older by race/ethnicity and sex (NHANES: 2005-2006). Source: NCHS and NHLBI. NH – non-Hispanic. Source: NCHS and NHLBI. NH – non-Hispanic. 5.8 6.1 14.9 13.1 11.3 14.2 0 2 4 6 8 10 12 14 16 Men Women Percent of Population NH Whites NH Blacks Mexican Americans
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The Continuum of CV Risk in Type The Continuum of CV Risk in Type 2 Diabetes 2 Diabetes Adapted from American Diabetes Association. Diabetes Care . 2003;26:3160-3167. Tsao PS, et al. Arterioscler Thromb Vasc Biol. 1998;18:947-953. Hsueh WA, et al. Am J Med . 1998;105(1A):4S-14S. American Diabetes Association. Diabetes Care . 1998;21:310-314.
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Diagnostic Criteria for Metabolic Diagnostic Criteria for Metabolic Syndrome: Modified NCEP ATP III Syndrome: Modified NCEP ATP III AHA/NHLBI Scientific Statement; Circulation 2005; 112:e285-e290. ≥3 Components Required for Diagnosis Components Defining Level Increased waist circumference Men Women ≥ 40 in ≥ 35 in Elevated triglycerides ≥150 mg/dL (or Medical Rx) Reduced HDL-C Men Women <40 mg/dL <50 mg/dL (or Medical Rx) Elevated blood pressure ≥130 / ≥85 mm Hg (or Medical Rx) Elevated fasting glucose ≥100 mg/dL (or Medical Rx)
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IDF Criteria: Abdominal Obesity and Waist Circumference and Waist Circumference Thresholds Thresholds Men Women Europid ≥ 94 cm (37.0 in) ≥ 80 cm (31.5 in) South Asian ≥ 90 cm (35.4 in) ≥ 80 cm (31.5 in) Chinese ≥ 90 cm (35.4 in) ≥ 80 cm (31.5 in) Japanese ≥ 85 cm (33.5 in) ≥ 90 cm (35.4 in) AHA/NHLBI criteria: ≥ 102 cm (40 in) in men, ≥ 88 cm (35 in) in women Some US adults of non-Asian origin with marginal increases should benefit from lifestyle changes. Lower cutpoints (≥ 90 cm in men and ≥ 80 cm in women) for Asian Americans Alberti KGMM et al. Lancet 2005;366:1059-1062. | Grundy SM et al. Circulation 2005;112:2735-2752.
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Prevalence of the Metabolic Syndrome Among US Adults NHANES 1988-1994 Prevalence (%) 0 5 10 15 20 25 30 35 40 45 20-29 30-39 40-49 50-59 60-69 > 70 Men Women Age (years) Ford E et al. JAMA . 2002(287):356.
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