Metabolic Syndrome

Question 1

What is the definition of metabolic syndrome?

Answer 1

A cluster of common conditions that increases T2DM and CVD risk?

Question 2

What is the drives metabolic syndrome?

Answer 2

insulin resistance

Question 3

Insulin resistance drives MS and triggered by:

Answer 3

POST PRANDIAL HYPERINSULINEMIA → FASTING HYPERINSULINEMIA → HYPERGLYCEMIA → insulin resistance → MS

Question 4

What characterizes a person as having metabolic syndrome?

Answer 4

Insulin resistance along with a person has any of the three conditions:
Abdominal obesity
impaired glucose tolerance
↓HDL
↑triglycerides
 HTN

Question 5

central obesity is classified as?

Answer 5

waist circumference

Male > 40 inches, Female > 35 inches

Question 6

what does the fasting blood glucose need to be for a person to contribute to them having metabolic syndrome?

Answer 6

≥100 mg/dL or on specific medication or diagnosed with T2DM

Question 7

what does a persons blood pressure need to read for their HTN to contribute to them having Metabolic syndrome?

Answer 7

BP ≥ 130 mmHg systolic or ≥ 85 mm diastolic or on specific medication

Question 8

What does a persons triglyceride level need to be at for them to has this be a contributing criteria for metabolic syndrome

Answer 8

Triglycerides ≥ 150mg mg/dL or on specific medication

Question 9

What does a persons Low HDL need to be at in order to contribute to them having metabolic syndrome

Answer 9

Male < 40 mg/dL, Female <50 mg/dL

Question 10

The prevalence of Metabolic Syndrome is dependent on what?

Answer 10

Age, as we continue to age our risk for developing this condition increases because we are losing muscle mass and replacing it with fat.

Question 11

The prevalence of Metabolic syndrome is dependent on what physical characteristic?

Answer 11

weight
Weight dependent
Normal weight = 5% risk
Overweight 22% risk above 25 or 30 BMI
Obese 60% risk BMI>30
Weight gain increases MS risk
2.25 kg weight gain in 16 years = 21-45% ↑risk factor
↑ Waist circumference = identifies ~ 46% of pts at MS risk

Question 12

Prevalence of metabolic syndrome is higher in who

Answer 12

Continues to ↑ in women, but men are catching up

Common in Mexican-America women—other Latinos

Native Americans have highest ethnic prevalence

Question 13

what are other risk factors for metabolic syndrome?

Answer 13

High Carb diet
Type 2 Diabetes
CHD
Post-menopause due to estrogen level declining
Sedentary life style
Lower social economic status
No Alcohol- (having 1cup of wine, 1-2oz of hard liquor, 1 beer can be beneficial to protecting endothelial lining of arteries)
Smoking
Non-diet soft drinks
Parental history
Antipsychotics (atypical antipsychotics)

Question 14

what are the complications of metabolic syndrome

Answer 14

↑ Triglycerides, ↓ HDL, ↑ BP
Best predictors for MS complications and progression
T2DM, CVD
Obesity
-increases risk of cancer, fatty liver dz, osteoarthritis

Question 15

How does obesity affect adiponectin?

Answer 15

alters function and availability (due to Insulin Resistance)
Not able to Modulate food intake and energy expenditure
Not able to Suppress gluconeogenesis
Not able to increase insulin sensitivity

Question 16

what are the complications of metabolic syndrome and metabolic syndrome?

Answer 16

Cognitive Decline/Dementia

There’s a strong correlation between atherosclerosis and:
Vascular Dementia
Alzheimer’s Dementia
Mild cognitive impairment

Question 17

What is the progression of Metabolic syndrome?

Answer 17

Begins with Obesity and Insulin resistance:
The more presenting metabolic syndrome conditions are ↑ T2DM/CVD incidence

Question 18

what does the Framingham Risk score determine?

what are the parameters it uses to calculate your risk?

Answer 18

CVD risk in ASYMPTOMATIC patients within 10 years

Question 19

How do you prevent metabolic syndrome?

Answer 19

prevent/ reduce the risk factors
treat underlying causes by:
Exercise and diet
Exercise will ↓ Abdominal obesity = ↓ insulin resistance, LDL →↑insulin S and HDL

Pharmacotherapy
orlistat, phentermine (3 month use only)

Behavioral Modification ( for stress eating)

Bariatric surgery for BMI >40 kg/m2 or >35mg/m2 with co-morbidities

Question 20

What are the exercise recommendations?

Answer 20

150 min/wk plan—this is an optimal goal for obese patients
Decreases abdominal fat (men and women)
Increases glucose uptake in muscle
Liposuction does not ↑ insulin Sensitivity or ↓ CVD risks
Need to lose calories, to gain metabolic effect

Question 21

What are other treatment options for metabolic syndrome?

Answer 21

smoking cessation
Diet
- Lean poultry and fish, Low saturated fat, low GI, low density foods, diet plan

Question 22

what is gylcemic index

Answer 22

A measure of the rate of the rise in serum glucose from various food sources

Question 23

what is Glycemic load (GL)

Answer 23

GI + carb content = quality and quantity of carbs consumed
Whole grain  (low GL) = ↓ wt (rise on glucose level is slower)
Refined grain (High GL) = ↑ wt  (rise in glucose is faster)
↓ GL  = ↓ hunger signal and delay onset of next meal

Question 24

Other treament options for metabolic syndrome?

Answer 24

Treat underlying causes such as:

T2DM, dyslipidemia

T2DM: Drug Treatment alone will not solve the problem of MS more effectively than exercise and diet will

IFG: Metformin and life changes, but life style change is more effective.

Insulin resistance: Metformin, thiazolidinediones (TZDs) increase insulin sensitivity

Question 25

what are the treatment goals for dyslipidemia?

Answer 25

LDL cholesterol goal < 100mg/dL for:
T2DM/CVD
CVD risk factor >20% on the Framingham Risk SCORE

Question 26

what is the criteria for dyslipidemia intervention?

Answer 26

smoker
HTN (≥ 140/90 mmHg)
 FHx of premature CVD
1st degree ♂ relative < 65 years old
Age of patient
♂ ≥  55 years old
♀ ≥ 65 years old

Question 27

What are the treatment options for LDL-C lowering?

Answer 27

Life style modifications
1st choice:  Statins (HMG-CoA reductase inhibitors)
Rx therapy for LDL cholesterol lowering
Can ↓ CVD risk 20-30%
↓ 14-63% LDL-C 
LFTs and myopathy

Question 28

how does orlistat work

Answer 28

inhibits fat absorption with increased fecal fat (not completely metabolized), and decreases T2DM incidence.

Question 29

how does Ezetimibe work

Answer 29

LDL lowering drug

Question 30

how does phentermine work

Answer 30

appetite suppressant FDA approved for short term only.

Exercise: need cardiovascular eval before exercise. Exercise maintains loss body wt.

Question 31

Cholestyramine LDL lowering

Answer 31

10-15% ↓ in LDL-c
Can use with Statins/Nicotinic Acid
Increases Triglyceride levels

Question 32

Nicotonic Acid LDL lowering

Answer 32

< 20% ↓ in LDL-c

Can use with Bile acid sequestrants/Statins

Question 33

Fibrates LDL lowering

Answer 33

(fenofibrate, gemfibrozil)
lowers LDL-C and Triglycerides
Can use with Ezetimibe (Fenofibrate- more effective than gemfibrozil)
Avoid with Statins (gemfibrozil)

Question 34

Triglyceride lowering drugs

Answer 34

Fibrates (fenofibrate, gemfibrozil)
Most effective
35-50% ↓ Triglycerides
Fenofibrate >> gemfibrozil
Avoid with Statins 

Nicotinic Acid (Niacin, Vitamin B3)
<20-40% ↓ in Triglycerides
↑FBG

Omega-3 fatty acids
40% ↓ in Triglycerides

Question 35

HDL enhancing drugs

Answer 35

Statins, Fibrates, Bile acids:
 ↑ HDL-C 5-10%
Nicotinic Acid
 ↑ HDL-C 30%
Ezetimibe and Omega-3
 ↑ HDL-C 0%
Not clear that rising HDL-C alone has CVS benefit

Question 36

which drug increases HLD the most

Answer 36

Nicotinic acid

↑ HDL-C 30%

Question 37

Key points about non-statin Tx

Answer 37

Non-statin tx may have higher non-cardiovascular mortality

Fibrates and Statins together increase myopathy