代谢综合症预防心脏病的前景

Metabolic Syndrome: A Perspective in Preventive Cardiology Zhao Dong Department of Epidemiology Beijing Institute of Heart, Lung & Blood Vessel Diseases Beijing Anzhen Hospital Focuses of Current Debates in Metabolic Syndrome Definitions ? Etiology and pathophysiology ? Clinical importance ? Importance for CVD prevention ? Clinical Perspectives for MS Who are the MS patients ? (Diagnostic issue) Who need the clinical treatment among the MS patients and ? How to treat the MS patients ? (Treatment issue) The effectiveness of treatment strategies?( Treatment issue) The Proportion of MS by Different Criteria for Central Obesity Male Female Treatment Decision in MS Hypertension High BP High TG Diabetes IFG Central Obesity Low HDL-C Who needs treatment as MS patients? What are the specific targets of treatment for MS patients? Preventive Perspectives for MS If the major components of MS have common pathophysiological pathway ? If MS has unique value in prediction of CVD ? How to prevent MS ? If the components in MS have common pathophysiological pathway ? Human obesity is due to an excess production of free fatty 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 strongly 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 resistance Banting Lecture: Reaven GM 1988 Diabetes 37:1595 Hyperinsulinaemia % The Prevalence of Hyperinsulinaemia by Increasing Numbers of Components in Metabolic Syndrome (CMCS Study, 2002) % Percentages of Only One Component of Metabolic Syndrome in People with and without Hyperinsulinaemia HTG Hypertension Low HDL High Glucose (CMCS Study, 2002) Hyperinsulinaemia Insulin normal 不同 FFA和胰岛素抵抗水平时 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 FFA 2.0 2.8 NS 1.5 1.7 1.7 2.4 NS 2.1 2.1 2.1 3.9 NS 3.7 2.7 HOMA_IR 1.5 2.4 1.6 2.8 NS 2.5 3.8 1.9 5.4 NS 2.1 7.0 3.4 28.9 NS 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 Logistic回归分析回归分析 OR值值 OR 95%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 FFA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 Logistic回归分析回归分析 OR值值 If MS has unique value in prediction of CVD ? Studies of the Association between MS and All-cause Mortality Author YearOf Publish Study Sample size Follow-up (years) Lakka 2002 Kuopio Ischaemic Heart Disease Risk Factor Study, Finland 1209 11.4 Katzmarzy k 2004 Aerobics Center Longitudinal Study 19223 10.2 Hunt 2004 San Antonio Heart Study 2815 12.7 Ford 2004 National Health and Nutrition Examination Survey II Mortality Study 2431 13.5 Author Yearof publish Study Sample size Follow-up (years) Onat 2002 Turkish Adult Risk Factor Study, Turkey 2398 3 Lakka 2002 Kuopio Ischemic Heart Disease Risk Factor Study, Finland 1209 11.4 Resnick 2003 Strong Heart Study 2283 7.6 Katzmarzy k 2004 Aerobics Center Longitudinal Study 19223 10.2 Bonora 2004 Bruneck Study, Italy 888 5 Rutter 2004 Framingham Offspring Study 3037 6.9 Studies of the Association between MS and CVD Author Year Study Sample size Follow-up (years) McNeill 2005 Atherosclerosis Risk in Communities Study 12,089 11 Hunt 2004 San Antonio Heart Study 12,089 12.7 Ridker 2003 Womens Health Study 14,719 8 Sattar 2003 West of Scotland Coronary Prevention Study, U.K. 6,447 4.9 Girman 2004 Air Force/Texas Coronary Atherosclerosis Prevention Study 3,188 5 Ford 2004 National Health and Nutrition Examination Survey II Mortality Study 2,431 13.5 Studies of the Association between MS and CVD Author Year Study Sample size Follow-up (years) Laaksonen 2002 Kuopio Ischemic Heart Disease Risk Factor Study, Finland 958 4 Resnick 2003 Strong Heart Study 2283 7.6 Sattar 2003 West of Scotland Coronary Prevention Study, U.K. 5947 4.9 Lorenzo 2003 San Antonio Heart Study 1734 78 Stern 2004 Mexico City Diabetes Study, Mexico 1353 6.3 Studies of the Association between MS and Diabetes If MS has unique value in prediction of CVD ? 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 ? All proposed health project goals are developed and formulated from a health determinant perspective. Experiences from Sweden： Determinants 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 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 procedures 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 total expenditure on health bet