代谢综合症：预防心脏病的前景

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1、MetabolicSyndrome:APerspectiveinPreventiveCardiologyZhaoDongDepartmentofEpidemiologyBeijingInstituteofHeart,Lung&BloodVesselDiseasesBeijingAnzhenHospitalFocusesofCurrentDebatesinMetabolicSyndromeDefinitions??????Etiologyandpathophysiology??????Clinicalimportance???????ImportanceforCVDpreventi

2、on???????ClinicalPerspectivesforMS●WhoaretheMSpatients??(Diagnosticissue)●WhoneedtheclinicaltreatmentamongtheMSpatientsand??●HowtotreattheMSpatients??(Treatmentissue)●Theeffectivenessoftreatmentstrategies??(Treatmentissue)TheProportionofMSbyDifferentCriteriaforCentralObesityMaleFemaleTreatmen

3、tDecisioninMSHypertensionHighBPHighTGDiabetesIFGCentralObesityLowHDL-CWhoneedstreatmentasMSpatients?WhatarethespecifictargetsoftreatmentforMSpatients?PreventivePerspectivesforMS●IfthemajorcomponentsofMShavecommonpathophysiologicalpathway???●IfMShasuniquevalueinpredictionofCVD???●Howtoprevent

4、MS??IfthecomponentsinMShavecommonpathophysiologicalpathway???Humanobesity……isduetoanexcessproductionoffreefattyacidsfromtheselipolyticallyactivedepots.This,inturn,mightcausehyperinsulinemiaviareducedhepaticinsulinuptake,followedbyperipheralhyper-insulinemia,insulinresistanceand,perhaps,diabet

5、esmellitusandhypertension.BjorntorpPJClinHypertension19862:163…….ThesedatastronglysupporttheviewthatinsulinplayanimportantroleinregulationofHDLmetabolism.GolayAJLipidRes198728:10-18AtheroscleroticCVDIGTType2DMdyslipidemiaFFATGHDL-CBPInsulinresistanceBantingLecture:ReavenGM1988Diabetes37:1

6、595Hyperinsulinaemia%ThePrevalenceofHyperinsulinaemiabyIncreasingNumbersofComponentsinMetabolicSyndrome(CMCSStudy,2002)%PercentagesofOnlyOneComponentofMetabolicSyndromeinPeoplewithandwithoutHyperinsulinaemiaHTGHypertensionLowHDLHighGlucose(CMCSStudy,2002)HyperinsulinaemiaInsulinnormal不同FFA和胰岛

7、素抵抗水平时各种代谢综合征组份异常的患病率（%）腹部肥胖高TG血症低HDL-C血症高血糖高血压不同FFA和胰岛素抵抗水平时代谢综合征的患病率（%）代谢综合征患病率%FFA四分位分层胰岛素抵抗四分位分层腹部肥胖高TG血症低HDL-C血症高血糖高血压FFAⅠ─────Ⅱ2.02.8NS1.51.7Ⅲ1.72.4NS2.12.1Ⅳ2.13.9NS3.72.7HOMA_IRⅠ─────Ⅱ1.52.41.62.8NSⅢ2.53.81.95.4NSⅣ2.17.03.428.9NS调整年龄