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1、 FocusesFocuses of Current of Current Debates in Metabolic Debates in Metabolic SyndromeSyndrome DefinitionsDefinitions ? Etiology and Etiology and pathophysiologypathophysiology ? Clinical Clinical importanceimportance ? Importance forImportance for CVD preventionCVD prevention ? Clinical Perspecti
2、ves for MSClinical Perspectives for MS Who are the MS patients ? (Diagnostic issue)Who are the MS patients ? (Diagnostic issue) Who need the clinical treatment among the MS patients Who need the clinical treatment among the MS patients and ? and ? How to treat the MS patients ? (Treatment issue)How
3、to treat the MS patients ? (Treatment issue) The effectiveness of treatment strategies?( Treatment issue)The effectiveness of treatment strategies?( Treatment issue) The Proportion of MS by Different The Proportion of MS by Different Criteria for Central ObesityCriteria for Central Obesity Male Fema
4、leMale Female Treatment Decision in MSTreatment Decision in MS HypertensionHypertension High BPHigh BP HighHigh TG TG DiabetesDiabetes IFGIFG Central ObesityCentral ObesityLow HDL-CLow HDL-C Who needs treatment as MS patients? Who needs treatment as MS patients? What are the specific targets of trea
5、tment for MS patients?What are the specific targets of treatment for MS patients? Preventive Perspectives Preventive Perspectives for MSfor MS If the major components of MS have common If the major components of MS have common pathophysiological pathway ? pathophysiological pathway ? If MS has uniqu
6、e value in prediction of CVD ?If MS has unique value in prediction of CVD ? How to prevent MS ?How to prevent MS ? If the components in MS have If the components in MS have common pathophysiological common pathophysiological pathway pathway ? Human obesity is due to an excess production of free fatt
7、y acids from these lipolytically active depots. This, in turn, might cause hyperinsulinemia via reduced hepatic insulin uptake, followed by peripheral hyper- insulinemia, insulin resistance and, perhaps, diabetes mellitus and hypertension. Bjorntorp P J Clin Hypertension 1986 2:163 .These data stron
8、gly support the view that insulin play an important role in regulation of HDL metabolism. Golay A J Lipid Res 1987 28:10-18 Atherosclerotic CVD IGT Type 2 DM dyslipidemia FFA TG HDL-C BP Insulin resistanceInsulin resistance Banting Lecture: Reaven GM 1988 Diabetes 37:1595 Hyperinsulinaemia Hyperinsu
9、linaemia % The Prevalence of Hyperinsulinaemia The Prevalence of Hyperinsulinaemia by Increasing Numbers of Components in Metabolicby Increasing Numbers of Components in Metabolic SyndromeSyndrome (CMCS Study, 2002(CMCS Study, 2002 ) ) % Percentages of Only One Component of Metabolic SyndromePercent
10、ages of Only One Component of Metabolic Syndrome in People with and without Hyperinsulinaemia in People with and without Hyperinsulinaemia HTG HTG Hypertension Low HDL High GlucoseHypertension Low HDL High Glucose (CMCS Study, 2002(CMCS Study, 2002 ) ) Hyperinsulinaemia Insulin normal 不同FFA和胰岛素抵抗水平时
11、 各种代谢综合征组份异常的患病率（%） 腹 部 肥 胖 高 T G 血 症 低HDL-C血症 高 血 糖 高 血 压 不同FFA和胰岛素抵抗水平时 代谢综合征的患病率（%） 代 谢 综 合 征 患 病 率 % FFA四分位分层 胰岛素抵抗 四分位分层 腹部肥胖高TG血症低HDL-C 血症 高血糖高血压压 FFA 2.02.8NS1.51.7 1.72.4NS2.12.1 2.13.9NS3.72.7 HOMA_IR 1.52.41.62.8NS 2.53.81.95.4NS 2.17.03.428.9NS 调整年龄、性别、吸烟、饮酒、BMI、胰岛素抵抗指数 / FFA NS：无统计学显著性，未
12、进入方程 各种代谢综合征组份异常的各种代谢综合征组份异常的 多因素多因素LogisticLogistic回归分析回归分析OROR值值 OR95%CI FFA 3.1（1.9-5.2） 3.1（1.9-5.1） 4.1（2.5-6.7） HOMA_IR 1.8（1.1-3.0） 2.4（1.4-3.9） 7.0（4.2-11.8） 调整年龄、性别、吸烟、饮酒、BMI、胰岛素抵抗指数 / FFA FFAFFA与胰岛素抵抗和代谢综合征关系的与胰岛素抵抗和代谢综合征关系的 多因素多因素LogisticLogistic回归分析回归分析OROR值值 If MS has unique value in pr
13、edictionIf MS has unique value in prediction of CVD of CVD ? Studies of the Association between MS and All-cause Mortality Author Year Of Publish StudySample size Follow-up (years) Lakka2002 Kuopio Ischaemic Heart Disease Risk Factor Study, Finland 120911.4 Katzmarzy k 2004 Aerobics Center Longitudi
14、nal Study 1922310.2 Hunt2004 San Antonio Heart Study281512.7 Ford2004 National Health and Nutrition Examination Survey II Mortality Study 243113.5 Author Year of publish Study Sample size Follow-up (years) Onat2002 Turkish Adult Risk Factor Study, Turkey 23983 Lakka2002 Kuopio Ischemic Heart Disease
15、 Risk Factor Study, Finland 120911.4 Resnick2003 Strong Heart Study22837.6 Katzmarzy k 2004 Aerobics Center Longitudinal Study 1922310.2 Bonora 2004 Bruneck Study, Italy8885 Rutter 2004 Framingham Offspring Study 30376.9 Studies of the Association between MS and CVD AuthorYearStudy Sample size Follo
16、w-up (years) McNeill2005 Atherosclerosis Risk in Communities Study 12,08911 Hunt 2004San Antonio Heart Study12,08912.7 Ridker2003Womens Health Study14,7198 Sattar2003 West of Scotland Coronary Prevention Study, U.K. 6,4474.9 Girman 2004 Air Force/Texas Coronary Atherosclerosis Prevention Study 3,188
17、5 Ford 2004 National Health and Nutrition Examination Survey II Mortality Study 2,43113.5 Studies of the Association between MS and CVD AuthorYearStudy Sample size Follow-up (years) Laaksonen2002 Kuopio Ischemic Heart Disease Risk Factor Study, Finland 9584 Resnick2003Strong Heart Study22837.6 Satta
18、r2003 West of Scotland Coronary Prevention Study, U.K. 59474.9 Lorenzo2003 San Antonio Heart Study 173478 Stern2004 Mexico City Diabetes Study, Mexico 13536.3 Studies of the Association between MS and Diabetes If MS has unique value in If MS has unique value in prediction of CVD ?prediction of CVD ?
19、 MS(ATP III) and All-cause Death MS(ATPIII) and CVD MS (Modified ATPIII) and CVD MS(ATP III*) and CVD How to prevent MS How to prevent MS ? All proposed health project goals are developed and formulated from a healthhealth determinantdeterminant perspective. Experiences from SwedenExperiences from S
20、weden： Determinants of HealthDeterminants of Health By fully implementing the Plan, we can: prevent the causes of heart disease and stroke no longer waiting to treat the causes or their consequences, when the causes themselves can be prevented in the first place. Components in CVD Prevention and Con
21、trolComponents in CVD Prevention and Control Diets Tobacco alcohol Exercise Health Environments CAD Blood Pressure Hypertension Lipids Dyslipidemia Glucose Diabetes Weight Obesity Stroke Peripheral arterials diseases Death Disability Upstream Midstream Downstream Prevention Treatment Major cardiac p
22、rocedures In China (case numbers) 1973-95 Up to2002 PTCA 2000 180 000 CABG 1000 75 000 Coronary Stenting 30 73 300 Awareness, treatment & control rate of hypertension In China(2001) DF Gu et al. Tsung O. Cheng. Hypertension 2002 40:920 Inter. J Cardiology 2004 96:425 The comparison of per capita tot
23、al The comparison of per capita total expenditure on health between high income expenditure on health between high income countries and low & middle income countriescountries and low & middle income countries Adapted from WHO World Health Report 2002 25% quartile 50% quartile 75% quartile 25% quarti
24、le 50% quartile 75% quartile Components in CVD Prevention and ControlComponents in CVD Prevention and Control Diets Tobacco alcohol Exercise Health Environments CAD Blood Pressure Hypertension Lipids Dyslipidemia Glucose Diabetes Weight Obesity Stroke Peripheral arterial diseases Death Disability Upstream Midstream Downstream Prevention Treatment Main Target for National Action Upstream determinants for CVD prevention in low & middle income countries. Tobacco control Healthy Diets Exercise Alcohol control Thank you for your attention.