Metabolic Syndrome and CVD

Question 1

Metabolic Syndrome

AKA:
• (Metabolic) Syndrome X
• Insulin resistance syndrome
• Dysmetabolic syndrome

—-About 47 million adults in the United States (almost 25%) have metabolic syndrome, and the number continues to
grow…

1. \_\_\_\_\_\_\_\_\_causes include:
 Insulin resistance (abnormalities of insulin metabolism)
 Central obesity
 Physical inactivity
 Pro-inflammatory state
2. \_\_\_\_\_\_\_\_\_causes

Answer 1

Acquired

Genetic

Question 2

The metabolic syndrome is a
CLUSTER of the MOST
dangerous heart attack risk
factors:
Diabetes and pre-diabetes
Abdominal obesity
High cholesterol
High blood pressure

Answer 2

KNOW

Question 3

Metabolic syndrome is diagnosed when a patient has at least 3 of the following 5 conditions:

1. Fasting glucose ≥100 mg/dL
   (or receiving drug therapy for hyperglycemia)
2. Blood pressure ≥130/85 mm Hg
   (or receiving drug therapy for hypertension)
3. Triglycerides ≥150 mg/dL
   (or receiving drug therapy for hypertriglyceridemia)
4. HDL-C

Answer 3

KNOW

Question 4

Greater emphasis on __________ _________ as the core feature of the syndrome, making it an essential requirement for diagnosis

Answer 4

abdominal (visceral) obesity

Question 5

If BMI is over \_\_\_\_ kg/m2
central obesity can be
assumed and waist
circumference does NOT
need to be measured

Heart attacks are caused by blockages
that are LESS than ____%

Answer 5

30

70

Question 6

Pregnancy complications such as _______
and _________ _______ are associated with longterm risk for cardiovascular disease… EVEN when blood sugar and blood pressure return to normal after pregnancy

Answer 6

preeclampsia

gestational diabetes

Question 7

Inflammation and CVD

Blood Test for Inflammation:
C-reactive protein test
(hs-CRP)
Less than 1 mg = \_\_\_\_\_\_\_\_\_\_\_\_
2-3 mg = \_\_\_\_\_\_\_\_\_\_\_-
>3 =\_\_\_\_\_\_

**Higher CRP Causes Higher
Number of Heart Attacks
**Weight Influences CRP Levels

Answer 7

normal

moderate

high

Question 8

*NOTE: LDL is the most atherogenic lipoprotien – focus on reducing dietary
factors that INCREASE LDL

—-Evidence is accumulating that _____ might be an independent risk factor for metabolic syndrome,

Answer 8

sugar

Question 9

Adopting a _________ diet has been shown to be more effective at reducing cardiovascular deaths then statins (statins reduced heart attacks and strokes by
25%1; 30% reduction with Med diet2) – and more effective than a ____ ______ diet.

__Recommendations:
• Aim initially at slow reduction of 7%–10% from baseline weight

Answer 9

Mediterranean

low fat

Question 10

Level of __________ may predict risk of cardiovascular disease even better
than LDL cholesterol. Non-HDL number reflects all “bad” cholesterol
circulating in blood – not just LDL cholesterol but VLDL cholesterol levels as well.
—No specific therapies beyond_________ therapies per AHA

Answer 10

non-HDL

lifestyle

Question 11

Individuals who drink alcohol in moderation (~1 drink a day or less) are 14-25% less likely to develop heart disease compared to those who drink no alcohol at all
• Concluded that Alcohol content provides the health benefits NOT the type of alcoholic beverage (wine, beer
or spirits)
—- 1 drink a day for women and > 2 daily
drinks for men are harmful
—Drinking too much alcohol can raise ____________
—Can also lead to high blood pressure, heart failure and an increased calorie intake
—Found to lower LDL cholesterol in a dose-dependent linear
way

Answer 11

triglycerides

Question 12

The National Cholesterol Education Program
recommends that those with elevated cholesterol eat foods containing _____ __________ as a way to lower cardiovascular risk
—–Effectiveness has been shown with dosages of 2 to 3 grams plant stanols per day.

Answer 12

plant sterols

Question 13

Coenzyme Q10 (CoQ10)

—-Reported beneficial effect of CoQ10 in the prevention and treatment of heart disease – attributed to ability to improve energy production in cells, inhibit blood clot
formation, and act as antioxidant
—CoQ10 may lower ______ ________
—- May take 4 - 12 weeks before beneficial effects
–Taking CoQ10 at night may help with body’s
ability to use it

Answer 13

blood pressure

Question 14

Garlic

• –.Rich in a variety of powerful sulfur-containing compounds including thiosulfinates
• –Of which the best known compound is ______

Answer 14

allicin

Question 15

Dietary Fiber

1—Soluble Fiber
• Shown to help lower ______ _________
 Bind fecal bile acids – increase excretion of bile acid derived cholesterol
 Decreases dietary cholesterol absorption – bind bile acids, fats & lipids
 Bacteria ferments the fiber into acetate, propionate and buytrate which inhibit cholesterol synthesis
• Lowers TC and LDL by 5-15%
• Dose: ___-____ g/day of dietary sources of fiber – that includes at least 5 -10 g/day of soluble fiber
• Recommend in place of high saturated fat foods
—-Food sources: Oat bran,
oatmeal, beans, peas, rice
bran, barley, citrus fruits,
strawberries and apple pulp

Answer 15

blood cholesterol

25-30

Question 16

Insoluble Fiber
• Does NOT seem to help lower blood
cholesterol
• Important aid in normal \_\_\_\_\_\_\_\_ \_\_\_\_\_\_
• Food sources: Whole-wheat breads,
wheat cereals, wheat bran, cabbage,
beets, carrots, Brussels sprouts,
turnips, cauliflower and apple skin

Answer 16

bowel

function

Question 17

Omega-3 Fatty Acids
—-Clinical evidence suggests that EPA and DHA: Eicosapentaenoic acid and docosahexaenoic acid, the two omega-3 fatty acids found in fish oil

Hypertriglyceridemia
• There is strong scientific evidence from human trials that omega-3 fatty acids from fish or fish oil supplements (EPA + DHA) significantly reduce blood triglyceride levels
• Benefits appear to be ___-____________

An analysis of 17 clinical studies using fish oil
supplements found that taking ___or more grams of fish oil daily may reduce blood pressure in people with untreated hypertension

Answer 17

dose-dependent

3

Question 18

For adults with CVD:
• The American Heart Association recommends an omega-3 fatty acid supplement (as fish oils), 1 gram daily of EPA and DHA combined
For adults with hypertryglyceridemia:
• The American Heart Association recommends an omega-3 fatty acid supplement (as fish oils), 2 - 4 grams daily of EPA and DHA
NOTE: It may take at least __-___ weeks for benefits of fish oil supplements to be seen.

• —High doses of omega-3 fatty acids may increase the risk of _________ (3g or more)
• —- May increase the risk of hemorrhagic (bleeding) stroke

Answer 18

2 - 3

bleeding

Question 19

“Maintaining a healthy ______&________ offers the greatest potential of ALL known
approaches for reducing the risk for CVD”
—“Therapeutic lifestyle changes can generally be implemented less expensively than most ________ and, unlike single drug therapy, favorably impacts multiple cardiovascular disease risk factors.”

Answer 19

diet and lifestyle

medications

Question 20

‘Optimal’ Numbers

• Blood Pressure– Optimal is less 120/80mm/hg or less
• Total Cholesterol– optimal is less than _______mg/dL
• LDL– optimal is less than_______ mg/dL
• HDL– optimal is greater than ____ mg/dl
• Triglycerides– optimal is less than ______ mg/dl
• Waist Circumference– optimal is less than 30 inches (female)
• BMI– Optimal is less than 25
• CRP– Optimal is less than 1 mg/L
—-Weight
– BMI 18.5-24.9 kg/m2 & waist circumference ≤ 40” men, ≤ 35” women

Answer 20

200

100

50

150