Cardiometabolic Syndrome

Question 1

What % of the world’s adult population is estimated to have metabolic syndrome?

Answer 1

20-25%

Question 2

What risk of disease does metabolic syndrome confer?

Answer 2

3x risk of MI or stroke (and 2x risk of CVD mortality)

5x of T2DM

Question 3

What is the IDF definition of metabolic syndrome?

Answer 3

Abdominal obesity (>94cm in male or >80cm in females of European descent, >90cm for Asian males)+ 2 or more of:
Elevated TG (>1.7 mmol/L)
Low HDL-C (less than 0.9 in males, less than 1.3 in females)
(130/85 mmHg) or treatment
Hyperglycaemia (FPG >5.6 mmol/L or IGT or diagnosed T2DM)

Question 4

What is the relationship between insulin levels and major CHD events in non-diabetic patients?

Answer 4

High insulin level (suggesting insulin resistance) is a predictor of risk for a major CHD event in non-diabetic patients

Question 5

Describe the proposed pathophysiology of the metabolic syndrome and insulin resistance

Answer 5

xx

Question 6

When is a CV risk calculator NOT indicated?

Answer 6

In patients with existing CVD (includes PVD, cerebrovascular disease, etc), a strong FHx of premature CVD or patients with renal disease; these patients should be considered high risk and treated

Question 7

What treatment strategies are recommended for patients with metabolic syndrome?

Answer 7

Address glucose intolerance and prevent T2DM if relevant

Reduce CV risk by addressing dyslipidaemia and HTN

Question 8

Is there any evidence that diet and exercise in patients with IGT prevent development of T2DM? How is this achieved practically?

Answer 8

Yes; one study shows a 58% reduction in risk (as or more effective when compared to drug therapies)
Goals included ≥5% loss of body weight (maintained), less than 30% calories from fat, increased fibre, >= 30 mins moderate exercise/day

Question 9

What strategies may be useful in preventing development of T2DM in patients with IGT?

Answer 9

Diet and exercise program
Drug therapies (including metformin)
Bariatric surgery (including laparoscopic banding)

Question 10

What drug therapies provide the greatest reduction in CHD in high risk treatments?

Answer 10

Statins (30-40%)
ACEIs (20-25%)
Aspirin (10-15%)
Fibrates (second line after statins if high TGs and low HDL; 15-25%)

Question 11

What are the current lipid targets for high risk patients from the National Heart Foundation of Australia?

Answer 11

LDL less than 2.0 (or 1.8 if pre-existing CVD)
HDL >1.0 mmol/L
TGs less than 1.5
Non-HDL cholesterol (total cholesterol - HDL) less than 2.5

Question 12

Mr James Dawson, aged 56
Presents for advice on R knee pain that troubles him when walking (he has not seen a doctor for several years)
Nil significant PHx
35 packet year smoking Hx
Drinks 4-5 beers on Friday and Saturday nights
Works as a delivery van driver
FHx: mother developed T2DM aged 65, brother aged 52 has angina and coronary stent
O/E: BMI 27.8, BP 177/95, pulse 72
What additional information would help you evaluate Mr Dawson’s cardiometabolic risk?

Answer 12

Hx: FHx of DM and CVD, smoking and alcohol Hx
O/E: anthropometric measurements, vitals, cardiovascular exam (including examination of pulses, auscultation of vessels for bruits)
Ix: fasting glucose, OGTT, lipid profile, LFTs, UEC

Question 13

What were the findings of the INTERHEART study?

Answer 13

Abdominal obesity, hyperlipidaemia, smoking, T2DM and HTN increase risk of AMI by 2-4x

Question 14

What is the relationship between CVD mortality and metabolic syndrome?

Answer 14

Mortality is increased in patients with metabolic syndrome

Question 15

What are 2 other co-morbidities which a diagnosis of metabolic syndrome may prompt doctors to investigate for?

Answer 15

NASH

PCOS

Question 16

Mrs Deborah Smith, aged 47
Presents for a check-up as her older brother (aged 50) has just developed T2DM
PHx: HTN 5 years (ibesartan 300mg/day), overweight with irregular periods and mild hirsutism as teen, difficulty conceiving, gestational diabetes, gradual weight gain over past 20 years
Works as secondary school teacher
FHx: father was overweight and died of MI aged 64, mother has HTN, brother with T2DM
O/E: BMI 36.2, BP 152/82, pulse 74
What additional information would help you evaluate Mr Dawson’s cardiometabolic risk?
Is the Hx of irregular menstrual periods relevant?
Is the gestational diabetes Hx relevant?

Answer 16

Hx: FHx of DM and CVD, smoking and alcohol Hx,
O/E: anthropometric measurements, vitals, cardiovascular exam (including examination of pulses, auscultation of vessels for bruits)
Ix: fasting glucose, OGTT, lipid profile, LFTs, UEC

Hx of irregular periods may suggest PCOS

Gestational diabetes increases risk of T2DM diagnosis later in life

Question 17

What is the effect of metformin on the development of diabetes?

Answer 17

May delay

Question 18

What is the effect of laparoscopic banding surgery on the development of diabetes in morbidly obese patients?

Answer 18

May prevent