Criteri di riconoscimento della sindrome metabolica

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1 Criteri di riconoscimento della sindrome metabolica

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5 Measuring waist circumference: a practical guide from the NIDDK/NIH Place 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

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7 Perché è pericolosa J Am Coll Cardiol, 2007; 49: , doi: /j.jacc 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.

8 Flowchart of Article Inclusion Gami, A. S. et al. J Am Coll Cardiol 2007;0:j.jacc v Copyright 2007 American College of Cardiology Foundation. Restrictions may apply.

9 RR and 95% CI for Metabolic Syndrome and Incident Cardiovascular Events and Death, by Specific Outcomes Gami, A. S. et al. J Am Coll Cardiol 2007;0:j.jacc v Copyright 2007 American College of Cardiology Foundation. Restrictions may apply.

10 RR and 95% CI for Metabolic Syndrome and Incident Cardiovascular Events and Death Gami, A. S. et al. J Am Coll Cardiol 2007;0:j.jacc v Copyright 2007 American College of Cardiology Foundation. Restrictions may apply.

11 RR and 95% CI for Incident Coronary Heart Disease Events in Patients Without Prevalent Cardiovascular Disease Gami, A. S. et al. J Am Coll Cardiol 2007;0:j.jacc v Copyright 2007 American College of Cardiology Foundation. Restrictions may apply.

12 CONCLUSIONS The 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.

13 Frequenza e prevalenza nella popolazione

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16 Prevalenza Specifica della Sindrome Metabolica secondo la la Distribuzione Geografica India > 20 Iran > 30 Irlanda Oman > 20 Turchia > 35 Australia > 35 Francia USA > 19 USA (Mex) Maschi Femmine 33:351-37Cameron 37Cameron et al. Endocrinol.Metab.Clin.North Am. 2004; 6

17 Prevalenza Specifica della Sindrome Metabolica nella Popolazione Italiana NordOvest NordEst Centro Sud/Isole 5 0 SM/Maschi SM/Femm DM/Maschi DM/Femm

18 Prevalenza di malattia Coronarica nella Popolazione USA>50 anni (dati Nhanes III) 20 19,2 Prevalenza CHD % ,7 No MS/No DM 13,9 7,5 MS/No DM DM/No MS DM/MS Men 8,7 13,9 7,5 19,2 % della popolazione 54,2% 28,7% 2,3% 14,8% Alexander et al. Diabetes 2003; 52:

19 Perché così alta prevalenza oggi?

20 Obesity Trends Among U.S. Adults BRFSS, 1990 No Data <10% 10%-14% 15-19% 20% Source: Mokdad AH.

21 Obesity Trends Among U.S. Adults BRFSS, 1994 No Data <10% 10%-14% 15-19% 20% Mokdad AH, et al. JAMA: 1999; 282: 16

22 Obesity Trends Among U.S. Adults BRFSS, 1998 No Data <10% 10%-14% 15-19% 20% Mokdad AH, et al. JAMA: 1999; 282: 16

23 Obesity Trends Among U.S. Adults BRFSS, 2000 No Data <10% 10%-14% 15-19% 20% Mokdad AH, et al. JAMA: 2001; 286: 10

24 Elemento comune: Insulinoresistenza

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26 the ability of insulin to promote glucose uptake was experimentally demonstrated in 1949 The biological actions of insulin are mediated by specific cell surface receptors that were first described in 1971

27 Effetti generali dell insulino-resistenza

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29 Ormoni del tessuto adiposo e insulinoresistenza.

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31 da L insulino Resistenza nel 2004 U.Di Mario et Al.

32 Insulino resistenza e apparato cardiovascolare Recettori meccanismi azioni

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37 Sindrome metabolica, insulino resistenza e steatoepatite

38 massa adiposa Fegato normale (normale sensibilità insulinica) 1 st hit FFA PPARα enzimi ossidazione FFA ossidazione FFA TNF- α IKKβ Resistenza insulinica epatica IKKβ UCP-2 Stress ossidativo Steatosi Insulino-resistenza 2 nd hit ROS NASH

39 the two hit hypothesis Insulino-resistenza 1 st hit Predisposizione genetica Normale Steatosi 2 nd hit Stress ossidativo Steatoepatite

40 attivazione delle cellule stellate

41 Cyp 2E1 Cyp4A Leptina Perossidazione Lipidica attivazione delle cellule stellate Ferro TNFα IL6, IL 8 Chemochine PDGF VEGF CTGF accumulo di matrice fibrillare TGFβ1 CTGF Fibrosi Cirrosi

42 Rischio cardiovascolare globale: Valutazioni classiche

43 Framingham08 F.mht

44 strumenti.exe

45 Rischio cardiovascolare globale: Rischi residui e associazione a Sindrome Metabolica: HDL Trigliceridi Steatosi epatica Policistosi ovarica OSAS Ipogonadismo maschile

46 Factors Contributing to Cardiometabolic Risk Brunzell, J. D. et al. J Am Coll Cardiol 2008;0:j.jacc v Copyright 2008 American College of Cardiology Foundation. Restrictions may apply.

47 Obiettivi terapeutici nella sindrome metabolica

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