Eduardo de Marchena M.D., F.A.C.C., F.A.C.P. Professor of Medicine & Surgery

1. Obesity , Metabolic Syndrome and Diabetes in Hispanics: implications on Cardiovascular Disease 2011 Eduardo de Marchena M.D., F.A.C.C., F.A.C.P. Professor of Medicine & Surgery Associate Dean for International Medicine & Director International Medicine Institute Director of Cardiovascular Center University of Miami Miller School of Medicine

3. Obesity Trends* Among U.S. AdultsBRFSS, 1985 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%

4. Obesity Trends* Among U.S. AdultsBRFSS, 1986 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%

5. Obesity Trends* Among U.S. AdultsBRFSS, 1987 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%

6. Obesity Trends* Among U.S. AdultsBRFSS, 1988 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%

7. Obesity Trends* Among U.S. AdultsBRFSS, 1989 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%

8. Obesity Trends* Among U.S. AdultsBRFSS, 1990 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%

9. Obesity Trends* Among U.S. AdultsBRFSS, 1991 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

10. Obesity Trends* Among U.S. AdultsBRFSS, 1992 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

11. Obesity Trends* Among U.S. AdultsBRFSS, 1993 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

12. Obesity Trends* Among U.S. AdultsBRFSS, 1994 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

13. Obesity Trends* Among U.S. AdultsBRFSS, 1995 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

14. Obesity Trends* Among U.S. AdultsBRFSS, 1996 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

15. Obesity Trends* Among U.S. AdultsBRFSS, 1997 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20%

16. Obesity Trends* Among U.S. AdultsBRFSS, 1998 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20%

17. Obesity Trends* Among U.S. AdultsBRFSS, 1999 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20%

18. Obesity Trends* Among U.S. AdultsBRFSS, 2000 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20%

19. Obesity Trends* Among U.S. AdultsBRFSS, 2001 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

20. Obesity Trends* Among U.S. AdultsBRFSS, 2002 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

21. Obesity Trends* Among U.S. AdultsBRFSS, 2003 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

22. Obesity Trends* Among U.S. AdultsBRFSS, 2004 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

23. Obesity Trends* Among U.S. AdultsBRFSS, 2005 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

24. Obesity Trends* Among U.S. AdultsBRFSS, 2006 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

25. Obesity Trends* Among U.S. AdultsBRFSS, 2007 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

26. Obesity Trends* Among U.S. AdultsBRFSS, 2008 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

27. Obesity Trends* Among U.S. AdultsBRFSS, 2009 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

28. “Globesity” Colombia and Brazil 40% women in 2001

29. Prevalence of Obesity in Males

30. Prevalence of Obesity in Females

31. “Globesity”

32. Alarming trend for Obesity in Children

33. Evolution of Man Diet 50 years 2.5 million years Exercise

34. 2050 New Concept of Ideal Body Type

35. Number and Percentage of U.S. Population with Diagnosed Diabetes, 1958-2008 CDC’s Division of Diabetes Translation. National Diabetes Surveillance System available at http://www.cdc.gov/diabetes/statistics

36. However, the prevalence of chronicdiseasessuch as diabetes isrising, due to population aging but also to changes in lifestyle Prevalence estimates of diabetes, adults aged 20-79 years, 2010 Note: The data are age-standardised to the World Standard Population. Source: International Diabetes Federation (IDF) (2009), “Diabetes Atlas, 4th edition”.

37. 2008 1994 2000 2008 1994 2000 No Data <4.5% 4.5-5.9% 6.0-7.4% 7.5-8.9% >9.0% No Data <14.0% 14.0-17.9% 18.0-21.9% 22.0-25.9% >26.0% Age-adjusted Percentage of U.S. Adults Who Were Obese or Who Had Diagnosed Diabetes Obesity (BMI ≥30 kg/m2) Diabetes CDC’s Division of Diabetes Translation. National Diabetes Surveillance System available at http://www.cdc.gov/diabetes/statistics

38. State-specific Prevalence of Obesity* Among U.S. Adults, by Race/Ethnicity, 2006-2008 Black non-Hispanic White non-Hispanic Hispanic (*BMI 30)

39. Prevalence of Physician Diagnosed Type 2 diabetes in Adults age 20+ by Race/Ethnicity, and Years of Education (NHANES: 2003-2006). Source: NCHS and NHLBI. NH – non-Hispanic.

40. Prevalence of Diabetes Today

41. However, the prevalence of chronicdiseasessuch as diabetes isrising, due to population aging but also to changes in lifestyle Prevalence estimates of diabetes, adults aged 20-79 years, 2010 Note: The data are age-standardised to the World Standard Population. Source: International Diabetes Federation (IDF) (2009), “Diabetes Atlas, 4th edition”.

42. Global projection for the Diabetes Epidemic: 2003 – 2025 (millions)

43. Diabetes Caused by Excessive Weight per Global Region

44. Postprandial glucose 350 Fasting glucose 300 250 200 150 100 Atherosclerosis Insulin resistance Insulin level b-cell dysfunction The Increased Atherosclerosis Risk in Type 2 Diabetes Begins in the Prediabetic State Clinical Diagnosis Glucose(mg/dL) 200 mg/dl 126 mg/dl 250 %Relativeto Normal 200 150 100 At risk for diabetes 50 0 25 30 0 5 10 15 20 -10 -5 Years

45. Obesity Interrelationship Between Insulin Resistance, Abdominal Obesity and Atherosclerosis Insulin Resistance Hyper-glycemia H/T Hyperco- agulability Hypertri-glyceridemia Small LDL Pro-inflam- matory Endothel. dysfunctn Hyperinsulinemic mitogenesis Low HDL Atherosclerosis

46. Age-adjusted prevalence trends for high blood pressure in Adults age 20 and older by race/ethnicity and sex survey (NHANES: 1988-94, 1999-02 and 2003-06).Source: NCHS and NHLBI. NH- non-Hispanic.

47. Extent of Awareness, Treatment and Control of High Blood Pressure by Race/Ethnicity and Sex (NHANES: 1999-2006).Source: NCHS and NHLBI.

48. Trends in mean total serum cholesterol among adolescents ages 12-17 by race, sex, and survey (NHANES: 1976-80, 1988-94, 1999-02, 2003-04, and 2005-06).Source: NCHS and NHLBI.

49. 3 CHD Mortality and Hyperinsulinemia:Paris Prospective Study (n=943) P<0.01 2 CHD mortality (per 1,000) 1 0 29 30-50 51-72 73-114 115 Quintiles (pmol) of fasting plasma insulin Fontbonne AM et al. Diabetes Care. 1991;14:461-469.

50. Atherosclerosis in Diabetes • ~80% of all diabetic mortality • 75% from coronary atherosclerosis • 25% from cerebral or peripheral vascular disease • >75% of all hospitalizations for diabetic complications • >50% of patients with newly diagnosed type 2 diabetes have CHD National Diabetes Data Group. Diabetes in America. 2nd ed. NIH;1995.