The Metabolic Syndrome and the concept of Metabolic Risk

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The Metabolic Syndromeand the concept of
Metabolic Risk

• James M. Galloway, M.D., F.A.C.P., F.A.C.C.
• Regional Health Administrator, Region V
• Office of Public Health and Science

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NCEP Metabolic Syndrome definition(any three of
the five criteria)
BP gt130 or gt85 mmHg FPG gt100
mg/dl Triglycerides gt150 mg/dl HDL Women
lt50 mg/dl Men lt40 mg/dl Waist
Women gt35 inches Men gt40
inches
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IDF Metabolic Syndrome Definition

• High waist circumference plus (any two)
• Triglycerides - 150mg/dl or Rx
• HDL - women lt50mg/dl men lt40mg/dl or Rx
• BP - 130 or 85mg/Hg or Rx
• FPG - 100 mg/dl or diabetes
• Europids male 94cm female 80cm
• South Asians male 90cm female 80cm
• Japanese use 2
• Eastern Mediterranean Middle East use 1
• South American use 2
• Sub-Saharan African use 1

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Definitions of the Metabolic Syndrome

• We get a new definition about every 2 years
• We now have 7 definitions
• No definition has been accompanied by data on its
  sensitivity, specificity and positive predictive
  value

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For example
ATP III (2004)
AHA/NHLBI (2005)

• BP gt130 / gt85 mmHg gt130 or gt85 mmHg
• or on Rx.
• FPG gt100 mg/dl gt100 mg/dl
• Triglycerides gt150 mg/dl gt150 mg/dl
• HDL - Women lt50 mg/dl lt50 mg/dl
• - Men lt40 mg/dl lt40 mg/dl
• Waist - Women gt35 inches gt35 inches
• - Men gt40 inches gt40 inches

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And they identify quite different populations

• 34 of those with ATPIII-MS do not have WHO-MS
• 30 of those with WHO-MS do not have ATPIII-MS
• 38 of those with IDF-MS do not have ATPIII-MS

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Importance of Metabolic Syndrome and the risk of
an MI

• Mrs. Smith
• Female
• Age - 45
• FPG - 115
• SBP - 133/86
• Tri - 160
• BMI - 25
• HDL - 65
• LDL - 125
• Non-smoker

Mr. Jones Male Age - 55 FPG - 99 SBP -
160/95 Tri - 148 BMI - 30 HDL - 42 LDL -
160 Smoker
Metabolic syndrome? Yes
Metabolic syndrome? No
30-year risk of MI? 77
30-year risk of MI? 17
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LDL-C control in people with diabetes or
CHD (1994 2004)
60
50
40
Diabetes
Percent
30
CHD
ATP III
20
ADA
10
0
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
Wang YR, et al. Diabetes Care 282942-2944, 2005