401 Metabolic Syndrome Flashcards
Harmonising definition of metabolic syndrome
3 of the following. Waist circumference more than 94 cm in males of Europoid, African and Middle Eastern more than 90 cm in south Asian more than 85 cm in Japanese; more than 80 cm in females Europoid, African, Middle Eastern, more than 80 cm in South Asian and more than 90 cm in Japanese; Fasting triglyceride more than 150 mg/dl HDL less than 40 mg/dl; SBP more than 130 mmHg DBP more than 85 mmHg, FBS more than 100 mg/dl
strongly related to insulin resistance and risk of diabetes and CVD
intraabdominal circumference
key feature of the metabolic syndrome
central adiposity
True or false. No single gene explains the complex phenotype called the metabolic syndrome
True.
most accepted and unifying hypothesis to describe pathophysiology of the metabolic syndrome
insulin resistance
early major contributor to development of insulin resistance
overabundance of circulating fatty acids
most sensitive pathway of insulin action
inhibition of lipolysis in adipose tissue
pathologic mechanism to explain metabolic syndrome
leptin resistance
provides the unifying theory for aging and the predisposition to the metabolic syndrome
oxidative stress hypothesis
recently emerged as an important contributor to the development of obesity and related metabolic disorders
??
excellent marker of the insulin resistant condition
hypertriglyceridemia
other major lipoprotein disturbance in metabolic syndrome
reduction in HDL cholesterol
inhibitory to lipoprotein lipase further controbuting to hypertriglyceridemia
Increase in apoC-III
True or false. Hyperuricemia is another consequence of insulin resistance
True.
how does uric acid lead to hypertension
effect of uric acid on nitric acid synthase in the macula densa of the kidney and stimuation of the renin angiotensin aldosterone system
proinflammatory cytokines the reflect overproduction by the expanded adipose tissue mass
IL 1,6,18; resistin, TNF alpha, CRP
may be primary source of pro inflammatory cytokines locally and in the systemic circulation
adipose tissue macrophages
anti inflammatory cytokine produced exclusively by adipocytes
adiponectin
what is the action of adiponectin
enhances insulin sensitivity and inhibits many steps in the inflammatory process
True or false. Reductions in adiponectin levels are common in metabolic syndrome
True.
most common liver disease in part as a consequence of the insulin resistance of metabolic syndrome
NAFLD
True or false.Women with PCOS are 2-4 times more likely to have metabolic syndrome
True.
primary approach to metabolic syndrome
weight reduction
most important component in weight loss
calorie restriction
important for the maintenance of weight loss
increase in physical activity
reduction of how much leads to weight reduction of 1 lb per week
About 500 kcal restriction daily
anti hypertensive of choice for metabolic syndrome
ACEI
given to inhibit fat absorption in metabolic syndrome
orlistat
given to improve insulin mediated glucose update in muscle and adipose tissue
TZD
given to increase HDL cholesterol
nicotinic acid
can lead to weight loss but causes headache and nasopharyngitis
lorcaserin
side effect of lorcaserin
headache and nasopharyngitis
side effect of liraglutide
nausea and emesis
appetite suppressants approved by US FDA
phertermine/topiramate, lorcaserin, naltrexone/bupropion and high dose liraglutide
dose of liraglutide for weight loss vs in T2DM
3.0 mg liraglutide vs 1.8 mg in T2DM
statin dose of those patients with metabolic syndrome with diabetes and known ASCVD
high intensity statin atorvastatin 40-80 mg or rosuvastatin 20-40 mg
when should statin therapy by initiated if patient has metabolic syndrome but without diabetes
ASCVD score of 7.5%
first drug of choice for lowering LDL
statin
second line drug for choice for lowering LDL
ezetimibe
what drug may be given in patient with familial hypercholesterolemia with insufficient lowering of LDL on statins and ezetimibe
Proprotein convertase/kexin type 9 (PCSK9 ) inhibitor
why are cholestyramine, colestipol and colesevalam which are more effective than ezetimibe in lowering LDL is not given in patients with metabolic syndrome
they can increase triglyceride levels
drug of choice to lower triglyceride level
fibrate (gemfibrozil or fenofirate)
other drugs that lower triglyceride levels
nicotinic acid and omega 3 fatty acids
is the only currently available drug with predictable HDL cholesterol raiding properties
??
Physical activity advocated in the management of metabolic syndrome
60-90 min daily activity required
when is gastric bypass or vertical sleeve gastrectomy an option
BMI more than 40 with no cormorbities BMI more than 35 with comorbidites
