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Contemporary Management of Cardiometabolic Risk

Contemporary Management of Cardiometabolic Risk. A continuing epidemic: 2 of 3 US adults are overweight or obese. National Health and Nutrition Examination Surveys 1999-2004 US adults ≥20 years of age. Year of survey. Overweight = BMI 25-29.9 kg/m 2 Obesity = BMI ≥30 kg/m 2.

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Contemporary Management of Cardiometabolic Risk

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  1. Contemporary Management of Cardiometabolic Risk

  2. A continuing epidemic: 2 of 3 US adults are overweight or obese National Health and Nutrition Examination Surveys 1999-2004US adults ≥20 years of age Year of survey Overweight = BMI 25-29.9 kg/m2Obesity = BMI ≥30 kg/m2 Ogden CL et al. JAMA. 2006;295:1549-55.

  3. Parallel epidemics of diabetes and obesity 1994 2004 Diabetes <4% 4%-4.9% 5%-5.9% ≥6% Obesity (BMI ≥30 kg/m2) 10%-14% 15%-19% 20%-24% ≥25% CDC. www.cdc.gov.

  4. Defining cardiometabolic risk Risk factors linked to cardiovascular disease (CVD)and diabetes Adiposity Dyslipidemia Dysglycemia Hypertension Cardiometabolic risk factors Eckel RH et al. Circulation. 2006;113:2943-6.

  5. Associations of adiposity with CVD Insulin resistance Dysglycemia Dyslipidemia Left ventricular dysfunction Hypertension CAD Sleep apnea syndrome White = visceral fat area (VFA) Black = subcutaneous (sc) fat Matsuzawa Y. Nat Clin Pract Cardiovasc Med. 2006;3:35-42.

  6. Adiposity predicts mortality 3.0 2.5 2.0 Relative risk of 1.5 death 1.0 0 0 20 25 30 35 40 45 Current BMI (kg/m2) All men (n = 313,047; 42,173 deaths)All women (n = 214,218; 19,144 deaths) Adams KF et al. New Engl J Med. 2006;355:763-78.

  7. Adiposity associated with premature MI N = 906 consecutive patients with AMI 75 72.9 10.6 years earlier occurrence of MI 70 66.9 Age at presentation with AMI (years) 65 62.3 60 55 <25(n = 306) 25-30(n = 362) >30(n = 238) BMI (kg/m2) Suwaidi JA et al. Clin Cardiol. 2001;24:542-7.

  8. Majority of patients undergoing PCI are overweight or obese N = 9633 BMI <25 kg/m2(n = 1923) BMI ≥25 kg/m2(n = 7710) Gruberg L et al. J Am Coll Cardiol. 2002;39:578-84.

  9. Adverse consequences of chronic adiposity and ectopic fat Lipid overflow ectopic fat Muscle fat(Intracellular lipid) Cardiac functionInsulin sensitivityDyslipidemiaβ-cell functionAtherosclerosisNASH Altered FFA metabolism Altered release of adipokines Epicardial fat Liver fat andaltered function FFA = free fatty acidsNASH = nonalcoholic steatohepatitis Adapted from Després J-P, Lemieux I. Nature. 2006;444:881-7.Molavi B et al. Curr Opin Cardiol. 2006;21:479-85.

  10. Epicardial adipose tissue may be increased in visceral obesity Patient withvisceral obesity Patient withperipheral obesity • Hypertension • Diabetes • Dyslipidemia No metabolic complications Iacobellis G et al. Clin Cardiol. 2003;26:237.

  11. Adiposity in the development of NASH Adipose Insulin Leptin Adiponectin Fatty acids Liver Normal Steatosis(fatty liver) Steatohepatitis(steatosis and inflammation) Fibrosis(collagen deposition) Adapted from Ahima RS. Gastroenterology. 2007;132:444-6. Angulo P. N Engl J Med. 2002;346:1221-31.

  12. Visceral vs subcutaneous adiposity CT scans matched for BMI and total body fat Visceral obesity Fat mass: 19.8 kg VFA: 155 cm2 Subcutaneous (sc) obesity Fat mass: 19.8 kg VFA: 96 cm2 White = VFA Black = sc fat Després J-P. Eur Heart J Suppl. 2006;8(suppl B):B4-12.

  13. No significant change at 10-12 weeks BP Plasma glucose Plasma insulin Total-C, LDL-C, HDL-C, TG Adiponectin TNF-α IL-6 CRP Neutral effect of liposuction on cardiometabolic risk factors Magnetic resonance images Pre-liposuction sc fat Post-liposuction Klein S et al. N Engl J Med. 2004;350:2549-57.

  14. Central adiposity: Better marker of CVD than BMI N = 8802 HOPE Study participants 1.5 P = 0.14 P = 0.003 P = 0.0127 BMI, WHR, WC tertiles 1 Adjusted RR of CVD death First Second Third 0.5 0 BMI(kg/m2) WHR WC(cm) WC = waist circumferenceWHR = waist/hip ratio Dagenais GR et al. Am Heart J. 2005;149:54-60.

  15. A new vital sign: Waist circumference Abdominal adiposity Coronaryheart disease Hypertension Dyslipidemia RISK Dysglycemia Adapted from Després J-P et al. BMJ. 2001;322:716-20.

  16. Continued burden of disease Central adiposity, hypertension, dyslipidemia, and dysglycemia drive “cardiometabolic risk” Cardiometabolic risk is associated with substantial cardiovascular morbidity and mortality The ongoing epidemic of adiposity mandates evaluation of new approaches for managing cardiometabolic risk

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