代谢综合症：预防心脏病的前景.ppt

,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TG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,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 多因素Logistic回归分析OR值,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 多因素Logistic回归分析OR值,If MS has unique value in prediction of CVD ?,Studies of the Association between MS and All-cause Mortality,Studies of the Association between MS and CVD,Studies of the Association between MS and CVD,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 between high income countries and low & middle income countries,Adapted from WHO World Health Report 2002,25% quartile 50% quartile 75% quartile,Components 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