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"Metabolic Syndrome - Does the Diagnosis Make a Difference?"

Dr. Lawrence A. Leiter (biography)
English - 2005-01-21 - 43 minutes
(42 slides)
(7 questions)

Summary :
In this presentation Dr. Leiter discusses different aspects of the metabolic syndrome, such as its diagnosis, prevalence, associated cardiovascular risk, pathophysiology and therapeutic approaches.

The metabolic syndrome has been defined in different ways, such as by NCEP ATP III or WHO criteria, and a few studies have compared the prevalence of metabolic syndrome using both of these definitions (1,2,3) One such study from the NHANES III survey showed good concordance between NCEP ATP III and WHO criteria although some differences were observed, for example a higher prevalence rate was seen in African Americans with the WHO definition (1) compared to NCEP ATP III.

Increased all cause and CV mortality has been associated with the metabolic syndrome (2,3,4). NHANES III showed that people with diabetes and the metabolic syndrome had the highest prevalence of CHD (5), and the WOSCOPS study found that the risk of CHD and diabetes increased with the number of metabolic syndrome risk factors (6).

The pathophysiology of CVD in the metabolic syndrome involves environmental and genetic (7) as well as other (8) factors, and it should be noted that not all people diagnosed with the metabolic syndrome have measurable increased insulin resistance (9). There is evidence of a pro-inflammatory state in the metabolic syndrome (10) and C-reactive protein levels have been found to add prognostic information in terms of CV risk (11).

When treating the metabolic syndrome, prevention of diabetes and cardiovascular disease are important considerations, and Dr. Leiter gives an overview of different kinds of prevention trials done in patients with or without diabetes/CHD/metabolic syndrome. Benefits of a Mediterranean-style diet (12) and exercise are discussed, as well as pharmacological approaches to improving CV risk factors.

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Learning objectives :
After viewing this presentation the participant will be able to discuss:

- Studies comparing the prevalence of metabolic syndrome using different definitions
- Metabolic syndrome-associated CVD risk
- The underlying pathophysiology of the metabolic syndrome
- Therapeutic approaches for the metabolic syndrome

Bibliographic references :
1. Earl S. Ford, MD, MPH and Wayne H. Giles, MD, MSC. A Comparison of the Prevalence of the Metabolic Syndrome Using Two Proposed Definitions Diabetes Care 26:575-581, 2003.

2. Hu G, Qiao Q, Tuomilehto J, Balkau B, Borch-Johnsen K, Pyorala K; DECODE Study GroupPrevalence of the metabolic syndrome and its relation to all-cause and cardiovascular mortality in nondiabetic European men and womenArch Intern Med. 2004 May 24;164(10):1066-76.

3. Kelly J. Hunt, PhD; Roy G. Resendez, MA; Ken Williams, MS; Steve M. Haffner, MD; Michael P. Stern, MD National Cholesterol Education Program Versus World Health Organization Metabolic Syndrome in Relation to All-Cause and Cardiovascular Mortality in the San Antonio Heart Study Circulation. 2004;110:1251-1257.

4. Hanna-Maaria Lakka, MD, PhD; David E. Laaksonen, MD, MPH; Timo A. Lakka, MD, PhD; Leo K. Niskanen, MD, PhD; Esko Kumpusalo, MD, PhD; Jaakko Tuomilehto, MD, PhD; Jukka T. Salonen, MD, PhD The Metabolic Syndrome and Total and Cardiovascular Disease Mortality in Middle-aged Men JAMA. 2002;288:2709-2716.

5. Charles M. Alexander, Pamela B. Landsman, Steven M. Teutsch, and Steven M. Haffner. NCEP-Defined Metabolic Syndrome, Diabetes, and Prevalence of Coronary Heart Disease Among NHANES III Participants Age 50 Years and Older Diabetes 52:1210-1214, 2003.

6. Naveed Sattar, MD; Allan Gaw, MD; Olga Scherbakova, MSc; Ian Ford, PhD; Denis St.J. O’Reilly, MD; Steven M. Haffner, MD; Chris Isles, MD; Peter W. Macfarlane, DSc; Chris J. Packard, DSc; Stuart M. Cobbe, MD; James Shepherd, MD Metabolic Syndrome With and Without C-Reactive Protein as a Predictor of Coronary Heart Disease and Diabetes in the West of Scotland Coronary Prevention Study Circulation. 2003;108:414.

7. Zimmet P.Addressing the insulin resistance syndrome: a role for the thiazolidinedionesTrends Cardiovasc Med. 2002 Nov;12(8):354-62.

8. Abhiram Prasad and Arshed A. Quyyumi."Renin-Angiotensin System and Angiotensin Receptor Blockers in the Metabolic Syndrome." Circulation 2004 110: 1507 - 1512.

9. Youlian Liao, PHD, Soonho Kwon, MD, Sara Shaughnessy, MS, RD, Penny Wallace, MS, RN, Amy Hutto, RN, Alicia J. Jenkins, MD, Richard L. Klein, PHD,5 and W. Timothy Garvey, MDCritical Evaluation of Adult Treatment Panel III Criteria in Identifying Insulin Resistance With Dyslipidemia Diabetes Care 27:978-983, 2004.

10. Devaraj S, Rosenson RS, Jialal I.Metabolic syndrome: an appraisal of the pro-inflammatory and procoagulant status.Endocrinol Metab Clin North Am. 2004 Jun;33(2):431-53.

11. Paul M Ridker, MD; Julie E. Buring, ScD; Nancy R. Cook, ScD; Nader Rifai, PhD C-Reactive Protein, the Metabolic Syndrome, and Risk of Incident Cardiovascular Events: An 8-Year Follow-Up of 14 719 Initially Healthy American Women Circulation. 2003;107:391.

12. Katherine Esposito, MD; Raffaele Marfella, MD, PhD; Miryam Ciotola, MD; Carmen Di Palo, MD; Francesco Giugliano, MD; Giovanni Giugliano, MD; Massimo D'Armiento, MD; Francesco D'Andrea, MD; Dario Giugliano, MD, PhD. Effect of a Mediterranean-Style Diet on Endothelial Dysfunction and Markers of Vascular Inflammation in the Metabolic Syndrome: A Randomized Trial JAMA. 2004;292:1440-1446.


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