Cardiometabolic Syndrome in Elderly Women

1. Rachel McLaughlin PharmD candidate University of Georgia November 6, 2012 Cardiometabolic Syndrome in Elderly Women

2. Metabolic Syndrome • ATP III defined a multiplex risk factor for cardiovascular disease (CVD) • Abdominal obesity (increased waist circumference) • Dyslipidemia (raised TGs and low HDL) • Elevated blood pressure • Insulin resistance +/- glucose intolerance • Proinflammatory state (elevated CRP) • Prothrombotic state (elevated plasma plasminogen activator inhbitor and prothrombin)

3. Metabolic Syndrome • Underlying CVD risk factors • Obesity, physical inactivity, atherogenic diet • Major risk factors • Cigarette smoking, hypertension, high LDL, low HDL, family history of premature CHD, aging • Emerging risk factors • High TGs, small LDL particles, insulin resistance, glucose intolerance, proinflammatory state, prothrombotic state

4. Metabolic Syndrome • At least three of the following:

5. Metabolic Syndrome

6. Metabolic Syndrome • Increase in risk of CVD outcomes with increasing number of traits • CVD is the primary clinical outcome, but MetS also increases risk for type 2 diabetes and susceptible to polycystic ovary disease, fatty liver, cholesterol gallstones, asthma, sleep disturbances and some cancers

7. Age- and sex-specific prevalence and ten-yearrisk for cardiovascular disease of all 16 risk factorcombinations of the metabolic syndrome -A cross-sectional studyCardiovascular Diabetology, August 2010

8. Methods • German Metabolic and Cardiovascular Risk Project (GEMCAS) data from 2005 • 35,869 participants • Ages 18-99, 61% women • Physicians recorded DM and CVD histories and assessed MetS risk factors according to a standardized assessment • Analyzed all 16 combinations of MetS risk factors association with 10-year risk of fatal and nonfatal MI • Calculated age-standardized prevalence rates to compare CV comorbidities prevalence with different combinations

9. Results

11. Results • Most frequent combination in both men and women: WC-BP-GL • More frequent in women than men: WC-HDL-BP • 10% vs 3% • In women, the 8 combinations with highest prevalence all included BP and 5 out of 8 included WC

12. Results • PROCAM analysis of 10-year risk for MI • Much higher in men than women • Women without MetS: 1.2% ; with: 2.3% • Highest risk combos for women: TG-HDL-BP-GL, WC-TG-HDL-BP, and all five traits combined • ESC score: 10-year risk of fatal MI • Women without MetS: 1.2% ; with: 1.8% • Highest risk combos for women: TG-HDL-BP-GL, WC-TG-HDL-BP

13. Discussion • There was a substantial influence of age and gender on the prevalence of combinations • Every GL combo more prevalent in elderly • Higher rates of WC in women • Each combination of MetS may not uniformly increase CV risk • HDL and BP frequent in high risk groups • Treat these as higher risk factors than the others??

15. Body composition and its association with cardiometabolic risk factors in the elderly: A focus on sarcopenic obesityArchives of Gerontology and Geriatrics: September 2012

16. Methods • 2943 Korean subjects 60 years or older • Body composition categorized into four groups: sarcopenic obese, sarcopenic nonobese, nonsarcopenic obese, and nonsarcopenic nonobese • Sarcopenia = appendicular skeletal muscle mass divided by weight <1 SD below the mean for young adults • Obesity = BMI >25 kg/m2 • Measured cardiometabolic risk factors • BP, glucose intolerance, lipid profiles, inflammatory markers, vitamin D level

17. Results • Sarcopenic obese group had most insulin resistance, metabolic syndrome, and CVD risk factors • Lowest HDL and vitamin D levels in the sarcopenic obese group • BP, glucose, lipid profiles -risk factors for CVD- significantly associated with the obese subjects

18. Discussion • Skeletal muscle is a primary tissue responsible for insulin-mediated glucose disposal so muscle loss causes diminished glucose disposal • High fat mass secretes proinflammatory adipocytokines • We need to focus on both obesity and muscle loss

20. What do we do? • Obesity • ATP III recommends tackling this first: lowers cholesterol, raises HDL, lowers blood pressure and glucose • Lose 10% of body weight • Reinforce with physical activity... help with sarcopenia • Insulin resistance • Blood pressure • Lipids • Several drugs will also lower CRP levels

21. For women, especially look at waist circumference, low HDL, high triglycerides and blood pressure as these caused the highest CV risk in elderly women • As people age, look carefully for signs of insulin resistance and treat appropriately • Exercise!

22. References • Chung, Ji-Youn, Hee-Taik Kang, Duk-Chul Lee, Hye-Ree Lee, Yong-Jae Lee. Body composition and its association with cardiometabolic risk factors in the elderly: A focus on sarcopenic obesity. Archives of Gerontology and Geriatrics. September 2012. • Grundy, Scott, Brewer, Jr,H. Bryan, Cleeman, James, Smith, Jr, Sidney, and Lenfant, Claude. Definition of Metabolic Syndrome: Report of the National Heart, Lung, and Blood Institute/ American Heart Association Conference on Scientific Issues Related to Definition. Circulation. 2004; 109:433-438. • Moebus, Susanne, Balijepalli, Chakrapani, Lösch Christian, Laura Göres, Bernd von Stritzky, Bramlage, Peter, Jürgen Wasem, Karl-Heinz Jöckell. Age- and sex-specific prevalence and ten-year risk for cardiovascular disease of all 16 risk factor combinations of the metabolic syndrome - A cross-sectional study. Cardiovascular Diabetology. 2010: 9:34.