2 - Metabolic Syndrome Flashcards
IDF definition of Metabolic Syndrome
A cluster of the most dangerous heart attack risk factors: diabetes and prediabetes, abdominal obesity, high cholesterol and high blood pressure.
Metabolic syndrome is defined by the presence of what and how many risk factors?
3 of: increase in fasting plasma glucose, increased blood pressure, low levels of plasma cholesterol bound to HDL, increased concentration of plasma triglycerides, and/or abdominal or central obesity.
Waist circumference thresholds
102cm in men, 88cm in women
Cardiometabolic risk factors are factors that can increase your risk of….
heart disease and diabetes
Examples of cardiometabolic risk factors
High triglycerides, high LDL-c, low HDL-c, inflammatory markers, elevated blood glucose, insulin resistance, high blood pressure, and intra-abdominal adiposity.
Global cardiometabolic risk factors (classical)
High blood glucose, high LDL, hypertension and smoking.
Global cardiometabolic risk factors (emerging)
Insulin resistance, low HDL, high triglycerides, inflammatory markers.
What concept is cardiometabolic risk based on?
Risk continuum.
Global cardiometabolic risk
The overall risk of developing type 2 diabetes and/or cardiovascular diseases, due to a cluster of modifiable risk factors.
Where is insulin produced?
the pancreas
What does insulin do?
Allows cells to take in glucose and use it for energy.
Insulin resistance
Cells no longer respond to insulin and therefor glucose can’t enter the cell.
Is CVD mortality decreased or increased in a person with metabolic syndrome?
Increased
What components of metabolic syndrome can predict coronary heart disease?
Thrombosis, hypertension, insulin resistance, atherosclerosis, and coronary artery disease.
What two diseases does metabolic syndrome increase the risk for?
Diabetes mellitus and cardiovascular disease.
What does visceral adipose tissue refer to?
Belly fat
What is visceral adipose tissue associated with?
High triglycerides, low HDL-C, small dense LDL particles, high insulin/glucose, high blood pressure, prothrombotic state, endothelial dysfunction, and atherosclerosis.
What are the two most significant risk factors for metabolic syndrome?
Insulin resistance and central obesity
In what way is age a risk factor for metabolic syndrome?
The prevalence of metabolic syndrome increases with age.
What races or ethnic groups have a higher risk of metabolic syndrome?
African-american and mexican-american.
What BMI and what type of obesity is a risk factor for metabolic syndrome?
BMI 25+ and abdominal fat.
What types of histories can be a risk for metabolic syndrome?
Family history, history of type 2 diabetes, and/or a history of diabetes during pregnancy.
What other diseases can increase your risk for metabolic syndrome?
Hypertension, CVD, polycystic ovary syndrome.
Why is belly fat specifically a risk factor as opposed to all fat?
Belly fat secretes inflammatory substances.
With insulin resistance, what parts of your body can’t use the insulin?
Muscles, fat, and liver cells.
How does the pancreas respond to insulin resistance?
It produces more and more insulin.
What happens to glucose if a person has insulin resistance?
Glucose builds up in the blood stream
What levels of glucose after an overnight fast is considered to be an indicator of prediabetes?
6.1 - 6.9 mmol/L (according to guidelines)
99-120mg/dl (According to Dr. Pollard)
Most people diagnosed with prediabetes will develop diabetes in how many years?
10 years
How does hypertension lead to atherosclerosis?
High blood pressure exerts mechanical stress on the arteries. This results in chronic endothelial damage and the onset of atherosclerosis.
Thrombogenicity
The tendency of a material in contact with the blood to form a blood clot.
Pro-thrombotic state
Endothelial dysfunction, enhanced coagulation, impaired fibrinolysis, platelet dysfunction, and a higher risk for venous thrombosis.
Fibrionolysis
Clot prevention
How do macrophages trigger inflammation?
Macrophages invade excess adipose tissue, resulting in the release of cytokines. Cytokines trigger inflammation.
How does inflammation trigger CVDs?
Inflammation increases the likelihood of plaque rupture.
What is endothelial dysfunction?
Damage to the insides of arteries.
What is the primary clinical outcome of hyperglycemia?
Microvascular disease (chronic kidney disease and diabetic retinopathy)
What does microvascular disease excellerate?
Development of congestive heart failure. Also contributes to atherogenesis.
Atherogenesis
Development of plaques inside blood vessel walls.
How does metabolic syndrome progress without treatment?
Metabolic syndrome -> Pre-diabetes -> Diabetes/CVD
Complications of metabolic syndrome
Type 2 diabetes, essential hypertension, PCOS, nonalcoholic fatty liver disease, sleep apnea, CVDs, and cancer.
Odds ratio
A measure of association between an exposure and an outcome. The OR represents the odds that an outcome will occur given a particular exposure, compared to the odds of the outcome occurring in the absence of that exposure.
Risk ratio.
The ratio of the probability of an event occurring in an exposed group to the probability of the event occurring in a comparison, non-exposed group.
A risk ratio of less than 1 means…
A reduction in risk in the exposed group.
A risk ratio of more than 1 means…
Exposed group has a higher risk than unexposed group.
Odds ratio equals 1
Exposure does not affect odds of outcome
Odds ratio less than 1
Exposure associated with higher odds of outcome
Odds ratio greater than 1
Exposure associated with lower odds of outcome
Risk ratio equals 1
Exposure associated with the same odds of outcome.
What is the #1 risk factor for metabolic syndrome?
Age
What percent of the population has metabolic syndrome?
20%
Incidence of metabolic syndrome increases with…
Age and increase in obesity
Is there any specific pharmacotherapy for metabolic syndrome?
No.
What are the 3 underlying causes responsible for the epidemic of metabolic syndrome?
Environmental causes, insulin resistance, and inflammation.
Primary prevention of metabolic syndrome
Lifestyle changes: weight reduction, change in dietary choices, and an increase in physical activity.
Secondary prevention of metabolic syndrome
Screening and public education.
Types of secondary prevention screening for metabolic syndrome
Screening for blood sugar/A1C, lipids, blood pressure.
Tertiary prevention
Minimize risk of type 2 diabetes and CVD, by treating each component/risk factor, such as obesity, glucose intolerance, insulin resistance, lipid disorders and hypertension.
Determinants that can influence how hungry a person is…
Biological, ecological, physical, social, psychological, and attitudes/beliefs/knowledge about food.
