Criteri di riconoscimento della sindrome
metabolica
Measuring waist circumference: a
practical guide from the
NIDDK/NIH
z Place a tape measure around
the bare abdomen, just above
the hip bone
z Be sure the tape is snug, but
does not compress the skin
z The tape should be parallel to
the floor
z The patient should relax and
exhale while the measurement
is made
http://win.niddk.nih.gov/publications/tools.htm#circumf
Perché è pericolosa
J Am Coll Cardiol, 2007; 49:403-414, doi:10.1016/j.jacc.2006.09.032
REVIEW AND META-ANALYSIS
Metabolic Syndrome and Risk of Incident
Cardiovascular Events and Death
A Systematic Review and Meta-Analysis of
Longitudinal Studies
Apoor S. Gami, Brandi J. Witt, Daniel E. Howard, Patricia J. Erwin, Lisa A.
Gami, Virend K. Somers, and Victor M. Montori.
Flowchart of Article Inclusion
Gami, A. S. et al. J Am Coll Cardiol 2007;0:j.jacc.2006.09.032v1-12569
Copyright ©2007 American College of Cardiology Foundation. Restrictions may apply.
RR and 95% CI for Metabolic Syndrome and Incident Cardiovascular Events and Death, by
Specific Outcomes
Gami, A. S. et al. J Am Coll Cardiol 2007;0:j.jacc.2006.09.032v1-12569
Copyright ©2007 American College of Cardiology Foundation. Restrictions may apply.
RR and 95% CI for Metabolic Syndrome and Incident Cardiovascular Events and Death
Gami, A. S. et al. J Am Coll Cardiol 2007;0:j.jacc.2006.09.032v1-12569
Copyright ©2007 American College of Cardiology Foundation. Restrictions may apply.
RR and 95% CI for Incident Coronary Heart Disease Events in Patients Without Prevalent
Cardiovascular Disease
Gami, A. S. et al. J Am Coll Cardiol 2007;0:j.jacc.2006.09.032v1-12569
Copyright ©2007 American College of Cardiology Foundation. Restrictions may apply.
CONCLUSIONS
The best available evidence suggests that people with MetSyn
are at increased risk of cardiovascular events. These results
can help clinicians counsel patients to consider lifestyle
interventions, and should fuel research of other preventive
interventions.
Frequenza e prevalenza nella popolazione
Prevalenza
Prevalenza Specifica
Specifica della
della Sindrome
Sindrome Metabolica
Metabolica
secondo
secondo la
la Distribuzione
Distribuzione Geografica
Geografica
45
40
35
30
25
20
15
10
5
0
In
d
ia
>
20
Ir
a
n
Ir
>
la
nd 30
a
5
O 0-6
m
an 9
Tu
>
rc
20
h
i
A
us a >
tr
al 35
Fr ia
an > 3
ci
5
a
30
U -64
U
SA SA
(M >
ex 19
)3
979
Maschi
Femmine
33:35133:351-37Cameron et al. Endocrinol.Metab.Clin.North Am. 2004; 6
Prevalenza
Prevalenza Specifica
Specifica della
della Sindrome
Sindrome Metabolica
Metabolica
nella
nella Popolazione
Popolazione Italiana
Italiana
30
25
20
NordOvest
NordEst
Centro
Sud/Isole
15
10
5
0
SM/Maschi SM/Femm DM/Maschi DM/Femm
Prevalenza di malattia Coronarica nella Popolazione
USA>50 anni (dati Nhanes III)
19,2
Prevalenza CHD %
20
15
10
13,9
8,7
7,5
5
0
Men
% della popolazione
No MS/No
DM
MS/No DM DM/No MS
DM/MS
8,7
13,9
7,5
19,2
54,2%
28,7%
2,3%
14,8%
Alexander et al. Diabetes 2003; 52:
1210-1214.
Perché così alta prevalenza oggi?
Obesity Trends Among U.S.
Adults
BRFSS, 1990
No Data
Source: Mokdad AH.
<10%
10%-14%
15-19%
≥20%
Obesity Trends Among U.S.
Adults
BRFSS, 1994
No Data
<10%
10%-14%
Mokdad AH, et al. JAMA: 1999; 282: 16
15-19%
≥20%
Obesity Trends Among U.S.
Adults
BRFSS, 1998
No Data
<10%
10%-14%
Mokdad AH, et al. JAMA: 1999; 282: 16
15-19%
≥20%
Obesity Trends Among U.S.
Adults
BRFSS, 2000
No Data
<10%
10%-14%
Mokdad AH, et al. JAMA: 2001; 286: 10
15-19%
≥20%
• Elemento comune:
– Insulinoresistenza
the ability of insulin to promote glucose uptake was experimentally
demonstrated in 1949
The biological actions of insulin are mediated
by specific cell surface receptors that were first described in
1971
Effetti generali dell’insulino-resistenza
Ormoni del tessuto adiposo e insulinoresistenza.
da “L’insulino Resistenza nel 2004” U.Di Mario et Al.
• Insulino resistenza e apparato
cardiovascolare
– Recettori meccanismi
– azioni
• Sindrome metabolica, insulino resistenza e
steatoepatite
↑massa adiposa
Fegato normale
(normale sensibilità insulinica)
↑TNF- α
↑FFA
PPARα
IKKβ
↑ enzimi ossidazione FFA
Resistenza insulinica
epatica
1st hit
↑ ossidazione FFA
IKKβ
Stress ossidativo
↑UCP-2
ROS
Steatosi
NASH
Insulino-resistenza
2nd hit
“the two hit hypothesis”
Insulino-resistenza
1st hit
Normale
Predisposizione genetica
Steatosi
2nd hit
Stress ossidativo
Steatoepatite
attivazione delle
cellule stellate
Cyp 2E1
Cyp4A
Perossidazione Lipidica
TNFα
attivazione delle
cellule stellate
Leptina
Ferro
IL6, IL 8
Chemochine
PDGF
VEGF
CTGF
accumulo di matrice fibrillare
TGFβ1
CTGF
Fibrosi
Cirrosi
• Rischio cardiovascolare globale:
– Valutazioni classiche
Framingham08 F.mht
strumenti.exe
• Rischio cardiovascolare globale:
– Rischi residui e associazione a Sindrome Metabolica:
• HDL
• Trigliceridi
• Steatosi epatica
• Policistosi ovarica
• OSAS
• Ipogonadismo maschile
Factors Contributing to Cardiometabolic Risk
Brunzell, J. D. et al. J Am Coll Cardiol 2008;0:j.jacc.2008.02.034v1-13753
Copyright ©2008 American College of Cardiology Foundation. Restrictions may apply.
Obiettivi terapeutici nella sindrome
metabolica