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)