criteri di riconoscimento della sindrome metabolica · da “l’insulino resistenza nel 2004”...
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Measuring waist circumference: a practical guide from the
NIDDK/NIHPlace a tape measure around the bare abdomen, just above the hip bone
Be sure the tape is snug, but does not compress the skin
The tape should be parallel to the floor
The patient should relax and exhale while the measurement is made
http://win.niddk.nih.gov/publications/tools.htm#circumf
Perché è pericolosaJ Am Coll Cardiol, 2007; 49:403-414, doi:10.1016/j.jacc.2006.09.032
REVIEW AND META-ANALYSIS
Metabolic Syndrome and Risk of Incident Cardiovascular Events and Death
A Systematic Review and Meta-Analysis of Longitudinal Studies
Apoor S. Gami, Brandi J. Witt, Daniel E. Howard, Patricia J. Erwin, Lisa A. Gami, Virend K. Somers, and Victor M. Montori.
Copyright ©2007 American College of Cardiology Foundation. Restrictions may apply.
Gami, A. S. et al. J Am Coll Cardiol 2007;0:j.jacc.2006.09.032v1-12569
Flowchart of Article Inclusion
Copyright ©2007 American College of Cardiology Foundation. Restrictions may apply.
Gami, A. S. et al. J Am Coll Cardiol 2007;0:j.jacc.2006.09.032v1-12569
RR and 95% CI for Metabolic Syndrome and Incident Cardiovascular Events and Death, by Specific Outcomes
Copyright ©2007 American College of Cardiology Foundation. Restrictions may apply.
Gami, A. S. et al. J Am Coll Cardiol 2007;0:j.jacc.2006.09.032v1-12569
RR and 95% CI for Metabolic Syndrome and Incident Cardiovascular Events and Death
Copyright ©2007 American College of Cardiology Foundation. Restrictions may apply.
Gami, A. S. et al. J Am Coll Cardiol 2007;0:j.jacc.2006.09.032v1-12569
RR and 95% CI for Incident Coronary Heart Disease Events in Patients Without Prevalent Cardiovascular Disease
CONCLUSIONSThe best available evidence suggests that people with MetSyn
are at increased risk of cardiovascular events. These results can help clinicians counsel patients to consider lifestyle interventions, and should fuel research of other preventive interventions.
Prevalenza Specifica della Sindrome Metabolica secondo la Distribuzione Geografica
Prevalenza Specifica della Sindrome Metabolica Prevalenza Specifica della Sindrome Metabolica secondo la Distribuzione Geograficasecondo la Distribuzione Geografica
33:35133:351--37Cameron et al. Endocrinol.Metab.Clin.North Am. 2004; 637Cameron et al. Endocrinol.Metab.Clin.North Am. 2004; 6
05
1015202530354045
India > 20
Iran > 30
Irlanda 5
0-69Oman
> 20Turch
ia > 35
Australia
> 35Francia
30-64
USA > 19
USA (Mex
) 39-7
9
MaschiFemmine
Prevalenza Specifica della Sindrome Metabolica nella Popolazione Italiana
Prevalenza Specifica della Sindrome Metabolica Prevalenza Specifica della Sindrome Metabolica nella Popolazione Italiananella Popolazione Italiana
0
5
10
15
20
25
30
SM/Maschi SM/Femm DM/Maschi DM/Femm
NordOvestNordEstCentroSud/Isole
Prev
alen
za C
HD
%Pr
eval
enza
CH
D %
Alexander et al. Diabetes 2003; 52: Alexander et al. Diabetes 2003; 52: 12101210--1214.1214.
% della popolazione 54,2% 28,7%% della popolazione 54,2% 28,7% 2,3% 14,8%2,3% 14,8%
8,7
13,9
7,5
19,2
0
5
10
15
20
Men 8,7 13,9 7,5 19,2
No MS/No DM MS/No DM DM/No MS DM/MS
Prevalenza di malattia Coronarica nella Popolazione USA>50 anni (dati Nhanes III)
Obesity Trends Among U.S. Adults
BRFSS, 1994
Mokdad AH, et al. JAMA: 1999; 282: 16
No Data <10% 10%-14% 15-19% ≥20%
Obesity Trends Among U.S. Adults
BRFSS, 1998
Mokdad AH, et al. JAMA: 1999; 282: 16
No Data <10% 10%-14% 15-19% ≥20%
Obesity Trends Among U.S. Adults
BRFSS, 2000
No Data <10% 10%-14% 15-19% ≥20%
Mokdad AH, et al. JAMA: 2001; 286: 10
the ability of insulin to promote glucose uptake was experimentally demonstrated in 1949
The biological actions of insulin are mediatedby specific cell surface receptors that were first described in
1971
↑massa adiposa
Fegato normale
(normale sensibilità insulinica) ↑FFA
SteatosiNASH
↑ enzimi ossidazione FFA
PPARα
↑TNF- αIKKβ
↑ ossidazione FFA
Resistenza insulinica epatica
Stress ossidativo↑UCP-2
1st hit
2nd hit
IKKβ
ROS
Insulino-resistenza
“the two hit hypothesis”
1st hit
Normale Steatosi
2nd hit
Steatoepatite
Stress ossidativo
Insulino-resistenza
Predisposizione genetica
attivazione delle cellule stellate
IL6, IL 8 Chemochine
PDGFVEGFCTGF
TNFα
accumulo di matrice fibrillare
Cyp 2E1Cyp4A
Fibrosi
Cirrosi
Perossidazione Lipidica
TGFβ1CTGF
FerroLeptina
• Rischio cardiovascolare globale:
– Rischi residui e associazione a Sindrome Metabolica:• HDL• Trigliceridi• Steatosi epatica• Policistosi ovarica• OSAS• Ipogonadismo maschile
Copyright ©2008 American College of Cardiology Foundation. Restrictions may apply.
Brunzell, J. D. et al. J Am Coll Cardiol 2008;0:j.jacc.2008.02.034v1-13753
Factors Contributing to Cardiometabolic Risk
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