Epidemiology of the Metabolic Syndrome

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Epidemiology of the Metabolic Syndrome
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• Marit Eika Jørgensen

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Insulin Resistance - Hidden Dangers
Type 2 Diabetes
Hyperinsulinemia IGT Dyslipidemia Hyperten
sion Coagulation abnormality
IGT impaired glucose tolerance
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Syndrome X
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• Reaven 1988
• Insulin resistance
• Glucose intolerance
• Raised triglycerides
• Low HDL cholesterol
• Hypertension

ECE 2003
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Visceral adipose tissue is associated with
metabolic risk
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_ Waist (cm) 104.0 104.5 WHR 0.91 0.92 CT
surface (cm2) 92.7 149.4 Ultrasound
(cm) 6.2 8.4
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The Metabolic Syndrome
Abdominal obesity Lipolysis FFA oxidation
Physical inactivity
VLDL Triglyceride HDL
Insulin resistance
Hypertension Endothelial dysfunction Microalbuminu
riai
Hyperglycemia
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The Metabolic SyndromeProposed definitions
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WHO Main criteria Insulin resistance OR DM / IGT
/ IFG Other components 1)Blood pressure
140/90 2)Dyslipidemia 3)Central
obesity 4)Microalbuminura (two or more)
ATPIII 1)Abdominal obesity 2)High
triglycerides 3)Low HDL cholesterol 4)Blood
pressure 130/85 5)High fasting
glucose (three or more)
EGIR Main criteria Insulin resistance Other
components 1)Hyperglycemia 2) Blood pressure
140/90 3)Dyslipidemia 4)Central obesity (two or
more)
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Prevalence of the Metabolic Syndrome in selected
countries (EGIR)
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MEN age gt 55 years
Percent
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The Metabolic SyndromeInter99 (n6.784)
Unpublished data Inter99
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Is the Metabolic Syndrome a useful entity?
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• Is insulin resistance a significant predictor of
  diabetes and CVD?
• Is the Metabolic Syndrome a predictor of incident
  diabetes?
• Is the Metabolic Syndrome a predictor of incident
  cardiovascular disease?

ECE 2003
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Is the Metabolic Syndrome a useful entity?
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• Is insulin resistance a significant predictor of
  diabetes and CVD?
• Is the Metabolic Syndrome a predictor of incident
  diabetes?
• Is the Metabolic Syndrome a predictor of incident
  cardiovascular disease?

ECE 2003
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Does hyperinsulinemia predict diabetes?
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Percent ()
Tertile of HOMA-IR
Resnick H et al. Diabetes Care 2003
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• Also demonstrated in
• - San Antonio Heart study
• - Mexico city Study
• - IRAS (Insulin resistance Atherosclerosis
  study)

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Does Hyperinsulinemia predict CVD?
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Does hyperinsulinemia predict IHD?
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fasting insulin mU/ml
Despres JP.N Engl J Med 1996
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Is the Metabolic Syndrome a useful entity?
________________________________________________

• Is insulin resistance a significant predictor of
  diabetes and CVD?
• Is the Metabolic Syndrome a predictor of incident
  diabetes?
• Is the Metabolic Syndrome a predictor of incident
  cardiovascular disease?

ECE 2003
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Does the metabolic syndrome predict incident
diabetes?
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__
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Does MS predict CVD?
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Percent
ATP III metabolic syndrome
Resnick H et al. Diabetes Care 2003
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Is the Metabolic Syndrome a useful entity?
________________________________________________

• Is insulin resistance a significant predictor of
  diabetes and CVD?
• Is the Metabolic Syndrome a predictor of incident
  diabetes?
• Is the Metabolic Syndrome a predictor of incident
  cardiovascular disease?

ECE 2003
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Does the metabolic syndrome predict CVD?
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__
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Is the Metabolic Syndrome a useful entity?
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• Is insulin resistance a significant predictor of
  diabetes and CVD? v
• Is the Metabolic Syndrome a predictor of incident
  diabetes? v
• Is the Metabolic Syndrome a predictor of incident
  cardiovascular disease? v

ECE 2003
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• .but prospective studies are required
• in different ethnic groups
• comparison between definitions

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Is the Metabolic Syndrome a useful entity?
YES

• To gain knowledge about the pathophysiology
  linking lifestylefactors, insulin resistance, and
  CVD risk factors
• to enable comparisons of metabolic risk between
  groups
• to predict incident CVD in patients with diabetes
• to predict incident Diabetes and CVD in non-DM

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-For preventive purposes
YES