Metabolic Syndrome Flashcards
What is the definition of metabolic syndrome?
A cluster of common conditions that increases T2DM and CVD risk?
What is the drives metabolic syndrome?
insulin resistance
Insulin resistance drives MS and triggered by:
POST PRANDIAL HYPERINSULINEMIA → FASTING HYPERINSULINEMIA → HYPERGLYCEMIA → insulin resistance → MS
What characterizes a person as having metabolic syndrome?
Insulin resistance along with a person has any of the three conditions: Abdominal obesity impaired glucose tolerance ↓HDL ↑triglycerides HTN
central obesity is classified as?
waist circumference
Male > 40 inches, Female > 35 inches
what does the fasting blood glucose need to be for a person to contribute to them having metabolic syndrome?
≥100 mg/dL or on specific medication or diagnosed with T2DM
what does a persons blood pressure need to read for their HTN to contribute to them having Metabolic syndrome?
BP ≥ 130 mmHg systolic or ≥ 85 mm diastolic or on specific medication
What does a persons triglyceride level need to be at for them to has this be a contributing criteria for metabolic syndrome
Triglycerides ≥ 150mg mg/dL or on specific medication
What does a persons Low HDL need to be at in order to contribute to them having metabolic syndrome
Male < 40 mg/dL, Female <50 mg/dL
The prevalence of Metabolic Syndrome is dependent on what?
Age, as we continue to age our risk for developing this condition increases because we are losing muscle mass and replacing it with fat.
The prevalence of Metabolic syndrome is dependent on what physical characteristic?
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
Prevalence of metabolic syndrome is higher in who
Continues to ↑ in women, but men are catching up
Common in Mexican-America women—other Latinos
Native Americans have highest ethnic prevalence
what are other risk factors for metabolic syndrome?
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)
what are the complications of metabolic syndrome
↑ Triglycerides, ↓ HDL, ↑ BP
Best predictors for MS complications and progression
T2DM, CVD
Obesity
-increases risk of cancer, fatty liver dz, osteoarthritis
How does obesity affect adiponectin?
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
what are the complications of metabolic syndrome and metabolic syndrome?
Cognitive Decline/Dementia
There’s a strong correlation between atherosclerosis and:
Vascular Dementia
Alzheimer’s Dementia
Mild cognitive impairment
What is the progression of Metabolic syndrome?
Begins with Obesity and Insulin resistance:
The more presenting metabolic syndrome conditions are ↑ T2DM/CVD incidence
what does the Framingham Risk score determine?
what are the parameters it uses to calculate your risk?
CVD risk in ASYMPTOMATIC patients within 10 years
How do you prevent metabolic syndrome?
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
What are the exercise recommendations?
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
What are other treatment options for metabolic syndrome?
smoking cessation
Diet
- Lean poultry and fish, Low saturated fat, low GI, low density foods, diet plan
what is gylcemic index
A measure of the rate of the rise in serum glucose from various food sources
what is Glycemic load (GL)
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
Other treament options for metabolic syndrome?
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
what are the treatment goals for dyslipidemia?
LDL cholesterol goal < 100mg/dL for:
T2DM/CVD
CVD risk factor >20% on the Framingham Risk SCORE
what is the criteria for dyslipidemia intervention?
smoker HTN (≥ 140/90 mmHg) FHx of premature CVD 1st degree ♂ relative < 65 years old Age of patient ♂ ≥ 55 years old ♀ ≥ 65 years old
What are the treatment options for LDL-C lowering?
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
how does orlistat work
inhibits fat absorption with increased fecal fat (not completely metabolized), and decreases T2DM incidence.
how does Ezetimibe work
LDL lowering drug
how does phentermine work
appetite suppressant FDA approved for short term only.
Exercise: need cardiovascular eval before exercise. Exercise maintains loss body wt.
Cholestyramine LDL lowering
10-15% ↓ in LDL-c
Can use with Statins/Nicotinic Acid
Increases Triglyceride levels
Nicotonic Acid LDL lowering
< 20% ↓ in LDL-c
Can use with Bile acid sequestrants/Statins
Fibrates LDL lowering
(fenofibrate, gemfibrozil)
lowers LDL-C and Triglycerides
Can use with Ezetimibe (Fenofibrate- more effective than gemfibrozil)
Avoid with Statins (gemfibrozil)
Triglyceride lowering drugs
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
HDL enhancing drugs
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
which drug increases HLD the most
Nicotinic acid
↑ HDL-C 30%
Key points about non-statin Tx
Non-statin tx may have higher non-cardiovascular mortality
Fibrates and Statins together increase myopathy
