代谢综合症：临床设置的第一时间准备

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1、TheMetabolicSyndrome:ReadyforPrimeTimeinClinicalSettings?YulingHong,MD,PhD,FAHA*Director,BiostatisticsandEpidemiologySeniorScienceandMedicineAdvisorAmericanHeartAssociationThepresentationdoesnotnecessarilyrepresenttheofficialpositionoftheAmericanHeartAssociationOutline

2、EvolutionofthetheMetabolicSyndrome(MetS).Clinicaldefinitionsandtheimplications.MajorhealthconsequencesoftheMetS.IsthemetabolicsyndromeausefulmarkerofCHDaboveandbeyondtheriskassociatedwithitsindividualcomponentsandothermajorCVDriskfactors?UnderlyingmechanismsbehindtheMe

3、tSandfactorsassociatedwithit.ManagementoftheMetS?FutureresearchdirectionsTheMetabolicSyndrome,alsoreferredtoasSyndromeX,SyndromeXPlustheInsulinResistanceSyndrome,Diabesity,theBig4,theDeadlyQuartet,the,theReavenSyndrome,isatermforconstellationofendogenousriskfactorsthat

4、increasetheriskofdevelopingbothatherosclerosticvasculardisease(ASCVD)andtype2diabetesmellitus.WhatistheMetS1923:Kylindescribedclusteringofhypertension,gout,andhyperglycemia1988:Reaven’sBantinglectureatADAAnnualConferencedescribedthetermofSyndromeX.1998:WorldHealthOrgan

5、izationfirstdefinedtheMetSforcliniciansandresearchers.2001:USNCEPATPIIIdefinitionfortheMetSwasreleased2005:IDFandAHA/NHLBIdefinitionoftheMetSforworldwideusewasreleasedEvolutionoftheMetSMajorabnormalitiesforSyndromeXinDr.Reaven1988BantingLecture1.  Hypertension2. Hyperg

6、lycemia3.  Glucoseintolerance4.  Elevatedserumtriglycerides5.LowserumHDLcholesterolObesitywasincludedandnocut-offpointsfortheseabnormalities.ProposedMetSDefinitionsWHO(1998)InsulinresistanceDM/IGT/IFG2ormoreof1)ObesityW/Hratio:0.9(m),0.85(w);BMI:>302)DyslipidemiaTG150

7、;HDL-c<35(m)/39(w)3)Bloodpressure≥140/904)Highglucose5)MicroalbuminuraEGIR(1999)Insulinresistance2ormoreof1)ObesityWC:94(m)/80(w)2)DyslipidemiaTG150;HDL-c<393)Bloodpressure≥140/90orRX4)HighglucoseIGTorIFG(butnotDM)ATPIII(2001)3ormoreof1)ObesityWC102(m)/88(w)2)HighTG

8、1503)LowHDL-C<40(m)/50(w)4)Bloodpressure≥130/855)Highglucose>110includingDMProposedMetSDefinitionsAACE(2003)IGT/IFG1