代谢综合症:临床设置的第一时间准备

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'代谢综合症:临床设置的第一时间准备'
The Metabolic Syndrome: Ready for Prime Time in Clinical Settings? Yuling Hong, MD, PhD, FAHA* Director, Biostatistics and Epidemiology Senior Science and Medicine Advisor American Heart Association The presentation does not necessarily represent the official position of the American Heart Association Outline? Evolution of the the Metabolic Syndrome( MetS). Clinical definitions and the implications.? Major health consequences of the MetS. Is the metabolic syndrome a useful marker of CHD above and beyond the risk associated with its individual components and other major CVD risk factors?? Underlying mechanisms behind the MetS and factors associated with it. ? Management of the MetS? ? Future research directions Syndrome X Plus Diabesity, the Big 4, the Deadly Quartet, the, the Reaven Syndrome, is a term for constellation of endogenous risk factors that increase the risk of developing both atherosclerostic vascular disease (ASCVD) and type 2 diabetes mellitus. Evolution of the MetS? 1923: Kylin described clustering of hypertension, gout, and hyperglycemia1988: Reaven’s Banting lecture at ADA Annual Conference described the term of Syndrome X. 1998: World Health Organization first defined the MetS for clinicians and researchers.?2001: US NCEP ATP III definition for the MetS was released?2005: IDF and AHA/NHLBI definition of the MetS for worldwide use was releasedWHO (1998) EGIR (1999) ATP III (2001)Insulin resistance Insulin resistanceDM / IGT / IFG 3 or more of2 or more of 2 or more of 1)Obesity1)Obesity 1) Obesity WC?102(m)/88(w)W/H ratio:0.9(m), WC:?94(m)/80(w) 2)High TG0.85(w);BMI: >30 2) Dyslipidemia ?1502)Dyslipidemia TG ?150;HDL-c<39 3)Low HDL-CTG ?150; 3) Blood pressure <40(m)/50(w)HDL-c<35(m)/39(w) ≥140/90 or RX 4)Blood pressure 3)Blood pressure 4) High glucose ≥130/85 ≥140/90 IGT or IFG (but not 5)High glucose4)High glucose DM) >110 including DM5)MicroalbuminuraAACE (2003) IDF (2005) AHA/NHLBIIGT / IFG Increase WC (2005) (population specific) 3 or more of1 or more of 2 or more of 1)Obesity1)Obesity 1) TG ?150 or Rx? WC?102(m)/88(w)*BMI: >30 2) HDL-c 2)High TG2)Dyslipidemia <40(m)/50(w) or RX ?150 or RxTG ?150; 3) Blood pressure 3)Low HDL-CHDL-c<40(m)/45(w) ≥130(S) or ≥85(D) <40(m)/50(w) or Rx3)Blood pressure or Rx 4)Blood pressure ≥130/85 4) High glucose ≥130(S) or ≥85(D)4)High glucose ≥ 100 including DM or Rx5)Other features of 5)High glucoseInsulin resistance >100 or Rx *90/80 for Asician APrevalence of Components of the MetS**US adults age 20 and over (1988-1994) Ford ES, et al. JAMA. 2002:287:356-359. Age-Adjusted Prevalence of the MetS: Results from the NHANES III Survey* 56.7% 25.7% Men difference 40 difference Women 35.6 35 30 28.3 24.8 25.7 25 22.8 20 16.4 P 15 r e v 10 a l e n 5 c e , 0 % White African American Mexican American*Criteria based on ATP III; diabetics were included in diagnosis; overall unadjusted prevalence was 21.8%. Ford ES, et al. JAMA. 2002;287:356-359.(%) 50 Men Women 45 40 35 30 25 20 15 10 5 0 20-70+ 20-29 30-39 40-49 50-59 60-69 >70 Age (years) Ford E et al. JAMA. 2002;287:356 Number of publication of the MetS in Medical LiteraturesYear of Number of Publicationspublication Anyway in the In the title only Citation1970 70 131980 79 301988 203 841990 260 911995 649 2782000 1097 4662004 2381 1180How is the MetS used by clinicians? ? On May 11, 2000, The US ICD-9-CM Coordinating and Maintenance Committee created a new ICD code for the MetS. ? The official name is Dysmetabolic S
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