METABOLIC SYNDROME Prof. Mohamad S. Al-Hadramy Professor of Medicine/Consultant KAUH-Dept. of Medicine Prof. Mohamad S. Al-Hadramy Professor of Medicine/Consultant KAUH-Dept. of Medicine

45 year-old F complaining of right hypochondrial pain,  by fat intake. Periods delayed 3-7 months. Parents: history of DM. Weight: 98 kg. Height: 155 cms. BMI: 40.8 Waist circumference: 106 cm. Plethoric face BP: 150/90 mmHg Few pink striae on abdomen Pigmented dark velvet skin: neck, axilla 45 year-old F complaining of right hypochondrial pain,  by fat intake. Periods delayed 3-7 months. Parents: history of DM. Weight: 98 kg. Height: 155 cms. BMI: 40.8 Waist circumference: 106 cm. Plethoric face BP: 150/90 mmHg Few pink striae on abdomen Pigmented dark velvet skin: neck, axilla

FBS: 7 mmol/l (126 mg/dl) T. Cholest.: 5.1 mmol/l (196 mg/dl) HDL: 0.6 mmol/l (23 mg/dl) LDL: 2.5 mmol/l (96 mg/dl) TG: 4.2 mmol/l (371 mg/dl) Alt: 70 IU/l (-55) AST, bilirubin: normal U/S: hyperechogenic Liver + Gall stones FBS: 7 mmol/l (126 mg/dl) T. Cholest.: 5.1 mmol/l (196 mg/dl) HDL: 0.6 mmol/l (23 mg/dl) LDL: 2.5 mmol/l (96 mg/dl) TG: 4.2 mmol/l (371 mg/dl) Alt: 70 IU/l (-55) AST, bilirubin: normal U/S: hyperechogenic Liver + Gall stones

It is a combination of metabolic abnormalities associated with increased risk for DM and cardiovascular disease. METABOLIC SYNDROME

1. Waist circumference: (≥ 102 cms M; ≥ 88 cm F) 2. TG > 150 mg/dl (1.7 mmol/l or treatment for elevated TG ) 3. HDL-C <40 mg/dl (0.9 mmol/l) M; <50 mg/dl (1.1 mmol/l) F; or treatment for ↓HDL-C 4. FB glucose ≥100 mg/dl (5.6 mmol/l) or treatment for ↑glucose 5. BP >130/85 or treatment for hypertension 1. Waist circumference: (≥ 102 cms M; ≥ 88 cm F) 2. TG > 150 mg/dl (1.7 mmol/l or treatment for elevated TG ) 3. HDL-C <40 mg/dl (0.9 mmol/l) M; <50 mg/dl (1.1 mmol/l) F; or treatment for ↓HDL-C 4. FB glucose ≥100 mg/dl (5.6 mmol/l) or treatment for ↑glucose 5. BP >130/85 or treatment for hypertension Criteria for Diagnosis Any 3 of the following: Criteria for Diagnosis Any 3 of the following:

CVD RISK FACTORS: Hypertension Dyslipidemia:  TG,  small LDL ↓ HDL,  APOB  Glucose  DM CVD RISK FACTORS: Hypertension Dyslipidemia:  TG,  small LDL ↓ HDL,  APOB  Glucose  DM

Prothombotic state:  fibrinogen  Factor VII  Plasminogen activator inhibitors. Prothombotic state:  fibrinogen  Factor VII  Plasminogen activator inhibitors.

Proinflammatory state:  cytokinase  C R P Proinflammatory state:  cytokinase  C R P

Underlying Causes: Obesity: risk correlates with waist. Insulin resistance Underlying Causes: Obesity: risk correlates with waist. Insulin resistance

Exacerbating Factors: Lack of exercise ↑ age Endocrine and genetic Exacerbating Factors: Lack of exercise ↑ age Endocrine and genetic

Progressive: Borderline RF ↑ Catagoric T2DM Progressive: Borderline RF ↑ Catagoric T2DM

CVD risk in MS 1.5 – 3 depending on stage of progression:    with DM. Risk rises geometrically with multiple risk factors. i.e., multiplicative rather than linear. CVD risk in MS 1.5 – 3 depending on stage of progression:    with DM. Risk rises geometrically with multiple risk factors. i.e., multiplicative rather than linear.

Other associated abnormalities : Fatty liver Gall stones Gout Obstructive sleep apnea Polycystic ovaries Other associated abnormalities : Fatty liver Gall stones Gout Obstructive sleep apnea Polycystic ovaries

Treatment : Life style modification (reduced weight, exercise) Antiatherogenic diet Treatment : Life style modification (reduced weight, exercise) Antiatherogenic diet

With progression : Treat individual risk factors: (e.g.,  BP, DM, dyslipidemia) With progression : Treat individual risk factors: (e.g.,  BP, DM, dyslipidemia)