Cardiometabolic Syndrome

Nabil Sulaiman
HOD Family and Community Medicine, Sharjah
University and University of Melbourne

&
Dr Dhafir A. Mahmood
Consultant Endocrinologist
Al- Qassimi & Al-Kuwait Hospital
Sharjah

Cardiometabolic Syndrome II
Aims

Abdominal obesity prevalence

Targeting Cardiometabolic Risk factors
Multiple Risk Factor management
A Critical Look at the Metabolic Syndrome

:Clustering of Components

Hypertension: BP. > 140/90

Dyslipidemia: TG > 150 mg/ dL ( 1.7 mmol/L )
HDL- C < 35 mg/ dL (0.9 mmol/L)
Obesity (central): BMI > 30 kg/M2
Waist girth > 94 cm (37 inch)
Waist/Hip ratio > 0.9
Impaired Glucose Handling: IR , IGT or DM
FPG > 110 mg/dL (6.1mmol/L)
2hr.PG >200 mg/dL(11.1mmol/L)
Microalbuninuria (WHO)

*Global cardiometabolic risk

* working definition

Gelfand EV et al, 2006; Vasudevan AR et al, 2005

International Diabetes Federation

(IDF) Consensus Definition 2005
The new IDF definition focusses on abdominal obesity
rather than insulin resistance

Why a New Definition of the

MeS: IDF Objectives
Needs:

To identify individuals at high risk of developing

cardiovascular disease (and diabetes)

To be useful for clinicians

To be useful for international comparisons

Fat Topography In Type 2

Diabetic Subjects

Intramuscular

Subcutaneous

Intrahepatic
Intraabdominal

FFA*
TNF-alpha*
Leptin*
IL-6 (CRP)*
Tissue Factor*
PAI-1*
Angiotensinogen*

Abdominal obesity and increased risk of

cardiovascular events

Adjusted relative risk

The HOPE study

Waist
circumference (cm):

1.4

Tertile 1

Men
<95

Women
<87

Tertile 2
Tertile 3

95103
>103

8798
>98

1.29

0.8

1.27

1.17

1.2
1

1.16
1

CVD death

1.35

1.14
1

MI

All-cause deaths

Adjusted for BMI, age, smoking, sex, CVD disease, DM, HDL-cholesterol, total-C;
CVD: cardiovascular disease; MI: myocardial infarction; BMI: body mass index;
DM: diabetes mellitus; HDL: high-density lipoprotein cholesterol
Dagenais GR et al, 2005

Abdominal obesity increases the risk of

developing type 2 diabetes
24

Relative risk

20
16
12
8
4
0
<71

7175.9

7681

81.186

86.191 91.196.3

>96.3

Waist circumference (cm)

Carey VJ et al, 1997

Abdominal obesity is linked to an

increased risk of coronary heart disease
Waist circumference has been shown to be independently
associated with increased age-adjusted risk of CHD, even after
adjusting for BMI and other cardiovascular risk factors
3.0

Relative risk

2.5

p for trend = 0.007

2.06

2.0
1.5

2.31

2.44

1.27

1.0
0.5
0.0

<69.8

69.8<74.2

74.2<79.2 79.2<86.3

86.3<139.7

Quintiles of waist circumference (cm)

CHD: coronary heart disease; BMI: body mass index
Rexrode KM et al, 1998

Diabetes in the new millennium

Interdisciplinary problem

Diabetes

Diabetes in the new millennium

Interdisciplinary problem

OBESITY

Diabetes in the new millennium

Interdisciplinary problem

DIAB
ESITY

Targeting

Cardiometabolic Risk

Central obesity: a driving force for

cardiovascular disease & diabetes
Front

Back

Balzac by Rodin

Insulin Resistance: Associated

Conditions

:Linked Metabolic Abnormalities

Impaired glucose handling/ insulin

resistance
Atherogenic dyslipidemia
Endothelial dysfunction
Prothrombotic state
Hemodynamic changes
Proinflammatory state
Excess ovarian testosterone production
Sleep-disordered breathing

:Resulting Clinical Conditions

Type 2 diabetes
Essential hypertension
Polycystic ovary syndrome (PCOS)
Nonalcoholic fatty liver disease
Sleep apnea
Cardiovascular Disease (MI, PVD, Stroke)
Cancer (Breast, Prostate, Colorectal,
Liver)

Multiple Risk Factor Management

Obesity
Glucose Intolerance
Insulin Resistance
Lipid Disorders
Hypertension
Goals: Minimize Risk of Type 2

Diabetes and Cardiovascular Disease

:Glucose Abnormalities

IDF:
FPG >100 mg/dL (5.6 mmol. L) or previously
diagnosed type 2 diabetes
(ADA: FBS >100 mg/dL [ 5.6 mmol/L ])

:Hypertension

IDF:
BP >130/85 or on Rx for previously
diagnosed hypertension

:Dyslipidemia

IDF:
Triglycerides - >150mg/dL (1.7 mmol /L)
HDL - <40 mg/dL (men), <50 mg/dL
(women)