39261-39271

39261-39271 - CardiometabolicSyndrome NabilSulaiman...

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Cardiometabolic Syndrome   Nabil Sulaiman Dr. Dhafir A. Mahmood
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Cardiometabolic Syndrome    Nabil Sulaiman HOD Family and Community Medicine,  Sharjah University and University of Melbourne Dr. Dhafir A. Mahmood Consultant Endocrinologist Al- Qassimi & Al-Kuwait Hospital Sharjah
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Cardiometabolic Syndrome II Aims o Abdominal obesity prevalence  o Targeting Cardiometabolic Risk factors o Multiple Risk Factor management o A Critical Look at the Metabolic Syndrome
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Clustering of Components o Hypertension: BP. > 140/90 o Dyslipidemia: TG > 150 mg/dL ( 1.7 mmol/L )                      HDL- C < 35 mg/dL (0.9 mmol/L) o Obesity (central): BMI > 30 kg/M2 Waist girth > 94 cm (37 inch) Waist/Hip ratio > 0.9  o Impaired Glucose Handling: IR, IGT or DM FPG > 110 mg/dL (6.1mmol/L) 2hr.PG >200 mg/dL (11.1mmol/L)                                    o Microalbuninuria (WHO)
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Global cardiometabolic risk* Gelfand EV et al , 2006; Vasudevan AR et al , 2005 * working definition
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The new IDF definition focuses on abdominal  obesity rather than insulin resistance International Diabetes Federation (IDF)  Consensus Definition 2005
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Why a New Definition of the MeS: IDF Objectives Needs o To identify individuals at high risk  of developing cardiovascular  disease (and diabetes) o To be useful for clinicians o To be useful for international  comparisons 
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Central Obesity o IDF: Central obesity - waist circumference >94 cm for  Europid men, >80 Europid women with ethnicity  specific values for other groups o WHO: Waist-hip ratio >0.9 - men or >0.85 - women o ATP III: Waist circumference >40 in. - men, >35 in. - women
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Fat Topography In  Type 2 Diabetic Subjects Intramuscular Intrahepatic Subcutaneous Intra- abdominal FFA * TNF-alpha * Leptin * IL-6 (CRP) * Tissue Factor * PAI-1 * Angiotensinogen *
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Abdominal obesity and increased risk of  cardiovascular events Dagenais GR  et al , 2005 Adjusted relative risk 1 1 1 1.17 1.16 1.14 1.29 1.27 1.35 0.8 1 1.2 1.4 CVD death MI All-cause deaths Tertile 1 Tertile 2 Tertile 3 Men Women <95 95–103 >103 <87 87–98 >98 Waist circumference (cm): The HOPE study Adjusted for BMI, age, smoking, sex, CVD disease, DM, HDL-cholesterol, total-C; CVD:  cardiovascular disease; MI: myocardial infarction; BMI: body mass index; DM: diabetes  mellitus; HDL: high-density lipoprotein cholesterol
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Abdominal obesity increases the risk  of developing type 2 diabetes <71 71–75.9 76–81 81.1–86 86.1–91 91.1–96.3 >96.3 24 20 16 12 8 4 0 Relative risk Waist circumference (cm) Carey VJ  et al , 1997
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Abdominal obesity is linked to an  increased risk of coronary heart disease Waist circumference has been shown to be independently  associated with increased age-adjusted risk of CHD, even after   adjusting for BMI and other cardiovascular risk factors 0.0 0.5 1.0 1.5 2.0 2.5 3.0 <69.8         69.8
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This note was uploaded on 02/26/2012 for the course PHARM 210 taught by Professor Staff during the Fall '10 term at Rutgers.

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39261-39271 - CardiometabolicSyndrome NabilSulaiman...

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