1、Expert Panel on Detection,Evaluation,and Treatment of High Blood Cholesterol in Adults.JAMA 2001;285:2486-2497.Atdischarge3 molaterAtdischarge%of Patients3 molaterNorhammar A et al.Lancet 2002;359:2140-2144.020406080100Conversion Status at Follow-upDiabetes(n=18)Normal(n=490)PBMI(kg/m2)28.2 1.127.2
2、0.2.472Centrality*1.38 0.091.16 0.2.472TG(mmol)1.83 0.121.26 0.10.006HDL-C(mmol)1.14 0.071.28 0.02.045SBP(mm Hg)116.8 3.0108.8 0.8.004Fasting glucose(mmol)5.28 0.15.00 0.02.032Fasting insulin(pmol)157 2781 5.006Haffner SM et al.JAMA 1990;263:2893-2898.*Ratio of subscapular to triceps skinfoldsNondia
3、beticthroughout the studyPrior todiagnosis ofdiabetesCopyright 2002 American Diabetes AssociationFrom Diabetes Care,Vol.25,2002;1129-1134Reprinted with permission from The American Diabetes Association.Relative RiskAfter diagnosis ofdiabetesDiabetic atbaseline01234560.700.750.800.850.900.951.00Years
4、5102001525Pyrl M et al.Circulation 1998;98:398-404.Log rank:Overall P=.001Q5 vs.Q1 P .001Q1Q2Q3Q4Q5Proportion without Major CHD Event0HOMA-IRQ1Q2Q3Q4Q5HDL-C(mg/dl)51.749.347.845.041.2LDL-C(mg/dl)115.7119.3125.0128.1124.8Cholesterol(mg/dl)188.0191.6197.9200.8199.0Triglyceride(mg/dl)105.7116.6129.7145
5、.4187.2Systolic BP(mm Hg)114.9116.5118.3119.3123.0Diastolic BP(mm Hg)69.070.471.973.175.4All p(trend)102 cm(40 in)88 cm(35 in)TG150 mg/dlHDL-CMenWomen40 mg/dl50 mg/dlBlood pressure130/85 mm HgFasting glucose110 mg/dlExpert Panel on Detection,Evaluation,and Treatment of High Blood Cholesterol in Adul
6、ts.JAMA 2001;285:2486-2497.4049Ford ES et al.JAMA 2002;287:356-359.Prevalence,%Age,years2029505970MenWomen0%10%20%30%40%50%0%10%20%30%40%Prevalence,%MenFord ES et al.JAMA 2002;287:356-359.WomenWhiteAfrican AmericanMexican AmericanOtherCHD Prevalence%of Population=8.7%13.9%7.5%19.2%0%5%10%15%20%25%Al
7、exander CM et al.Diabetes 2003;52:1210-1214.nFocus on obesity(especially abdominal obesity)as the underlying cause of the metabolic syndromenTherefore,prevent development of obesity in the general populationnAlso,treat obesity in the clinical setting(NHLBI/NIDDK Obesity Education Initiative)Variable
8、OddsRatioLower 95%LimitUpper 95%LimitWaist circumference1.130.851.51Triglycerides1.120.711.77HDL cholesterol*1.741.182.58Blood pressure*1.871.372.56Impaired fasting glucose0.960.601.54Diabetes*1.551.072.25Metabolic syndrome0.940.541.68Copyright 2003 American Diabetes AssociationFrom Diabetes,Vol.52,
9、2003;1210-1214Reprinted with permission from The American Diabetes Association.0%2%4%6%8%10%BMI per kg/m2HDL-C per mg/dl decreaseSBP per mm HgFPG per mg/dlStern MP et al.Ann Intern Med 2002;136:575-581.WHO.Definition,Diagnosis and Classification of Diabetes Mellitus and Its Complications:Report of a
10、 WHO Consultation.Geneva:WHO,1999.nInsulin resistance(type 2 diabetes,IFG,IGT)*nPlus any 2 of the following:nElevated BP(140/90 or drug Rx)nPlasma TG 150 mg/dlnHDL 35 mg/dl(men);30 and/or W/H 0.9(men),0.85(women)nUrinary albumin 20 mg/min;Alb/Cr 30 mg/g*Note that 1999 WHO uses hyperinsulinemic eugly
11、cemic clamp whereas 1998 WHO and EGIR use HOMA-IR.nWHO 1999 clinical definitionnYesnATP III 2001 clinical definitionnNo,but it is usually presentnMultiple metabolic risk factors are sufficientnObesity can produce the metabolic syndrome without insulin resistanceWHO.Definition,Diagnosis and Classific
12、ation of Diabetes Mellitus and Its Complications:Report of a WHO Consultation.Geneva:WHO,1999.|Expert Panel on Detection,Evaluation,and Treatment of High Blood Cholesterol in Adults.JAMA 2001;285:2486-2497.nFocus on insulin resistance as the underlying cause of the metabolic syndromenMore emphasis o
13、n the genetic basis of the metabolic syndrome rather than obesitynLeads to increased thinking about the use of drugs to treat insulin resistance in patients with the metabolic syndromenIf focus is on obesity as underlying causenPrevent and treat obesitynIf focus is on insulin resistance as underlyin
14、g causenTreat insulin resistancenIf focus is on metabolic risk factorsnTreat individual risk factorsnRisk of:nCHDnDMnRelation to:nInsulin resistancenObesitynPrevalence in community could differ by racenHow simple is the definition?nWhat is the impact of the metabolic syndrome on health outcomes?nCar
15、diovascular diseasenType 2 diabetesLakka HM et al.JAMA 2002;288:2709-2716.Cumulative Hazard,%026812Follow-up,yMetabolic Syndrome:Cardiovascular Disease MortalityRR(95%CI),3.55(1.986.43)410051015NCEP MetSWHO MetSTotal PopulationAll Cause1.43(1.101.87)1.25(0.961.63)CVD2.55(1.753.72)1.64(1.132.37)Disea
16、se Free*All Cause1.11(0.741.67)0.87(0.571.33)CVD2.04(1.143.63)0.77(0.381.55)Hunt KJ et al.Diabetes 2003;52:A221-A222.*Those without diabetes,cardiovascular disease,or cancer.Adjusted for age,gender,and ethnic group.%in Lowest Quartile of SiHanley AJ et al.Diabetes 2003;52:2740-2747.NeitherNCEP OnlyW
17、HO OnlyBothOverallHispanicsNon-Hispanic whitesAfrican Americans0102030405060708090Relative Risk3.0Ridker PM et al.N Engl J Med 2002;347:1557-1565.10+5924010510152025Copyright 2002 Massachusetts Medical Society.All rights reserved.Adapted with permission.CRPWBCFibrinogenBMI0.400.170.22Waist0.430.180.
18、27Systolic BP0.200.08*0.11Fasting glucose0.180.130.07*Fasting insulin0.330.240.18Si0.370.240.18Festa A et al.Circulation 2000;102:4247.*P0.05,P0.005,P0.0001CRP=C-reactive protein;IRS=insulin-resistance syndrome;WBC=white blood cell count.0Mean Value of Log CRPFesta A et al.Circulation 2000;102:4247.
19、Number of Metabolic Disorders12340.00.20.40.60.81.01.21.41.6FibrinogenCRPPAI-1Incidence,%1stFesta A et al.Diabetes 2002;51:1131-1137.2nd3rd4thQuartiles:0510152025Haffner SM et al.Circulation 2002;106:679-684.RosiglitazoneRosiglitazoneChange from Baseline to Week 26,%Placebo-50-40-30-20-100n=95n=124n
20、=134Haffner SM et al.Circulation 2002;106:679-684.RosiglitazoneRosiglitazonePlaceboChange from Baseline to Week 26,%-50-40-30-20-100n=91n=120n=1320123456hs-CRP(mg/L)Jialal I et al.Circulation 2001;103:1933-1935.nInsulin resistance is related to increased PAI-1,fibrinogen,and CRP levels cross-section
21、allynIncreased levels of PAI-1,CRP,and fibrinogen(weak)predict the development of type 2 diabetes.In some analyses,these associations are independent of obesity and insulin resistancenRosiglitazone,a TZD,decreases levels of PAI-1,CRP,and MMP-9nDiabetic subjectsnBlood pressure:YESnStatin therapy:YESn
22、Nondiabetic subjectsnLittle data availableAFCAPS/TexCAPSLovastatin15537%43%(NS)HPSSimvastatin291224%33%(p=.0003)CARE Pravastatin58623%25%(p=.05)4SSimvastatin20232%55%(p=.002)LIPIDPravastatin78225%19%4S ReanalysisSimvastatin48332%42%(p=.001)HPSSimvastatin198124%15%Downs JR et al.JAMA 1998;279:1615-16
23、22.|HPS Collaborative Group.Lancet 2003;361:2005-2016.|Goldberg RB et al.Circulation 1998;98:2513-2519.|Pyrl K et al.Diabetes Care 1997;20:614-620.|LIPID Study Group.N Engl J Med 1998;339:1349-1357.|Haffner SM et al.Arch Intern Med 1999;159:2661-2667.TrialDiabetic/TotalResultsSHEP583/4736BeneficialG
24、ISSI-32790/18,131BeneficialSyst-Eur492/4695BeneficialHOT1501/18,790BeneficialUKPDS1148BeneficialCAPPP572/10,985BeneficialCurb JD et al.JAMA 1996;276:1886-1892.|Zuanetti G et al.Circulation 1997;96:4239-4245.|Staessen JA et al.Am J Cardiol 1998;82:20R22R.|Hansson L et al.Lancet 1998;351:1755-1762.|UK
25、PDS Group.BMJ 1998;317:703-713.|Hansson L et al.Lancet 1999;353:611-616.010203040221Event Rate,%Ballantyne CM et al.Circulation 2001;104:3046-3051.SimvastatinPlacebo23726128418.020.319.036.901020304050607080Glycosylatedhemoglobin 6.5%Patients Reaching Intensive-Treatment Goals at Mean 7.8 y,(%)Gde P
26、 et al.N Engl J Med 2003;348:383-393.Intensive TherapyCholesterol175 mg/dlTriglycerides150 mg/dlSystolic BP130 mm HgDiastolic BP80 mm HgConventional TherapyP=0.06P0.001P=0.19P=0.001P=0.21Copyright 2003 Massachusetts Medical Society.All rights reserved.0102030405060Primary Composite Endpoint(%)Months
27、 of Follow-upGde P et al.N Engl J Med 2003;348:383-393.02448609636847212Copyright 2003 Massachusetts Medical Society.All rights reserved.nThe metabolic syndrome predicts the development of both diabetes and CHD nInsulin resistance and obesity characterize most individuals subjects with the metabolic
28、 syndrome,although not required features of the NCEP metabolic syndromenInitial therapy for the metabolic syndrome should consist of caloric restriction and increased physical activitynConventional cardiovascular risk factors such as lipids and blood pressure should be treated in individuals with th
29、e metabolic syndrome,although no recommendations have so far suggested intensification of risk factor managementnNo consensus exists on whether insulin sensitizers should be used in nondiabetic individuals with the metabolic syndrome谢谢您的聆听与观看THANK YOU FOR YOUR GUIDANCE.感谢阅读！为了方便学习和使用，本文档的内容可以在下载后随意修改，调整和打印。欢迎下载！汇报人：XXX日期：20XX年XX月XX日
