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METABOLIC SYNDROMEMETABOLIC SYNDROME
Prof. Mohamad S. Al-HadramyProfessor of
Medicine/ConsultantKAUH-Dept. of Medicine
Prof. Mohamad S. Al-HadramyProfessor of
Medicine/ConsultantKAUH-Dept. of Medicine
45 year-old F complaining of right hypochondrial pain, by fat intake. Periods delayed 3-7 months.Parents: history of DM.Weight: 98 kg. Height: 155 cms. BMI: 40.8Waist circumference: 106 cm.Plethoric faceBP: 150/90 mmHgFew pink striae on abdomenPigmented dark velvet skin: neck, axilla
45 year-old F complaining of right hypochondrial pain, by fat intake. Periods delayed 3-7 months.Parents: history of DM.Weight: 98 kg. Height: 155 cms. BMI: 40.8Waist circumference: 106 cm.Plethoric faceBP: 150/90 mmHgFew pink striae on abdomenPigmented dark velvet skin: neck, axilla
FBS: 7 mmol/l (126 mg/dl)T. Cholest.: 5.1 mmol/l (196 mg/dl)HDL: 0.6 mmol/l (23 mg/dl)LDL: 2.5 mmol/l (96 mg/dl)TG: 4.2 mmol/l (371 mg/dl)Alt: 70 IU/l (-55)AST, bilirubin: normalU/S: hyperechogenicLiver + Gall stones
FBS: 7 mmol/l (126 mg/dl)T. Cholest.: 5.1 mmol/l (196 mg/dl)HDL: 0.6 mmol/l (23 mg/dl)LDL: 2.5 mmol/l (96 mg/dl)TG: 4.2 mmol/l (371 mg/dl)Alt: 70 IU/l (-55)AST, bilirubin: normalU/S: hyperechogenicLiver + Gall stones
It is a combination of metabolic abnormalities associated with increased risk for DM and cardiovascular disease.
It is a combination of metabolic abnormalities associated with increased risk for DM and cardiovascular disease.
METABOLIC SYNDROMEMETABOLIC SYNDROME
1. Waist circumference: (≥ 102 cms M; ≥ 88 cm F)
2. TG > 150 mg/dl (1.7 mmol/l or treatment for elevated TG)
3. HDL-C <40 mg/dl (0.9 mmol/l) M; <50 mg/dl (1.1 mmol/l) F; or treatment for ↓HDL-C
4. FB glucose ≥100 mg/dl (5.6 mmol/l) or treatment for ↑glucose
5. BP >130/85 or treatment for hypertension
1. Waist circumference: (≥ 102 cms M; ≥ 88 cm F)
2. TG > 150 mg/dl (1.7 mmol/l or treatment for elevated TG)
3. HDL-C <40 mg/dl (0.9 mmol/l) M; <50 mg/dl (1.1 mmol/l) F; or treatment for ↓HDL-C
4. FB glucose ≥100 mg/dl (5.6 mmol/l) or treatment for ↑glucose
5. BP >130/85 or treatment for hypertension
Criteria for DiagnosisAny 3 of the following:
Criteria for DiagnosisAny 3 of the following:
CVD RISK FACTORS: Hypertension Dyslipidemia:
TG, small LDL↓ HDL, APOB Glucose DM
CVD RISK FACTORS: Hypertension Dyslipidemia:
TG, small LDL↓ HDL, APOB Glucose DM
Prothombotic state: fibrinogen Factor VII Plasminogen activator inhibitors.
Prothombotic state: fibrinogen Factor VII Plasminogen activator inhibitors.
Proinflammatory state: cytokinase C R P
Proinflammatory state: cytokinase C R P
Underlying Causes: Obesity: risk correlates with waist. Insulin resistance
Underlying Causes: Obesity: risk correlates with waist. Insulin resistance
Exacerbating Factors: Lack of exercise ↑ age Endocrine and genetic
Exacerbating Factors: Lack of exercise ↑ age Endocrine and genetic
Progressive: Borderline RF ↑ Catagoric T2DM
Progressive: Borderline RF ↑ Catagoric T2DM
CVD risk in MS 1.5 – 3 depending on stage of progression:
with DM.
Risk rises geometrically with multiple risk factors.i.e., multiplicative rather than linear.
CVD risk in MS 1.5 – 3 depending on stage of progression:
with DM.
Risk rises geometrically with multiple risk factors.i.e., multiplicative rather than linear.
Other associated abnormalities: Fatty liver Gall stones Gout Obstructive sleep apnea Polycystic ovaries
Other associated abnormalities: Fatty liver Gall stones Gout Obstructive sleep apnea Polycystic ovaries
Treatment: Life style modification (reduced weight, exercise) Antiatherogenic diet
Treatment: Life style modification (reduced weight, exercise) Antiatherogenic diet
With progression: Treat individual risk
factors:
(e.g., BP, DM, dyslipidemia)
With progression: Treat individual risk
factors:
(e.g., BP, DM, dyslipidemia)
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