1. Grazie per aver scelto di utilizzare a scopo didattico questo materiale delle Guidelines 2011 libra. Le ricordiamo che questo materiale è di proprietà dell’autore e fornito come supporto didattico per uso personale.

2. Diabetes obesity in patients with COPD Angelo Avogaro

3. Atherogenic dyslipidemia  Triglycerides  HDL-cholesterol  Cholesterol/HDL-cholesterol ratio "Normal" LDL-cholesterol but  apo B Small, dense LDL and HDL Postprandial hyperlipidemia Insulin resistance Hyperinsulinemia Hyperglycemia Type 2 diabetes Thrombotic state  PAI-1  Fibrinogen Inflammatory state  CRP  Cytokines  risk of acute coronary syndrome Metabolic risk factorsAbdominal obesity Inflammation Lipid core Thin fibrous cap CORONARY ATHEROSCLEROSIS UNSTABLE PLAQUE Intra-abdominal Obesity, Metabolic Risk Factors and CHD adapted from Despres, 2004

4. Adverse cardiometabolic effects of products of adipocytes Adipose tissue ↑ IL-6 ↓ Adiponectin ↑ Leptin ↑ TNF α ↑ Adipsin (Complement D) ↑ Plasminogen activator inhibitor-1 (PAI-1) ↑ Resistin ↑ FFA ↑ Insulin ↑ Agiotensinogen ↑ Lipoprotein lipase ↑ Lactate Inflammation Type 2 diabetes Hypertension Atherogenic dyslipidaemia Thrombosis Atherosclerosis Lyon 2003; Trayhurn et al 2004; Eckel et al 2005

5. 2001

7. COPD Inflammation May Contribute to Cardiovascular Disease Rennard. Proc Am Thorac Soc. 2005;2:94-100.

8. 38 COPD patients (age: 66 +/- 7 years, [mean +/- SD], FEV1: 43 +/- 16% 34 control participants matched for age and gender are included in this study. RESULTS: 47% of COPD patients and 21% of control participants presented metabolic syndrome. CONCLUSIONS: The presence of metabolic syndrome is frequent in patients with COPD who participated in a cardiopulmonary program. Hence, this population should be considered for screening for the metabolic syndrome. Marquis K et al, J Cardiopulm Rehabil. 2005 The metabolic syndrome in patients with chronic obstructive pulmonary disease

9. Peak YJ at al, Metabolism 2010

10. Log-transformed (log) hs-CRP (A), log interleukin-6 (B), fibrinogen (C), and physical activity level (D) according to GOLD stages and the absence or presence of the metabolic syndrome. Watz H et al. Chest 2009;136:1039-1046

11. 11 Visceral adipose tissue favours systemic inflammation Visceral tissue area (cm 2 ) Waist girth (cm) 100 120 140 160 180 200 220 1 1 1,3 90 94 98 102 106 110 1 1 1,2 1,2,3 Quintiles of PCR (1)(2)(3)(4)(5)(1)(2)(3)(4)(5) Lemieux I et al. Arterioscler Thromb Vasc Biol 2001;21:961-7. Quintiles of PCR

12. Sleep Disorders-Metabolic Syndrome Sleep Fragmentation Sleep Deprivation Intermittent Hypoxemia Increased Sympathetic Drive Sleep Disorders Metabolic Syndrome

13. Homeostasis model assessment in Respiratory Distress Syndrome Punjabi, N. M. et al. Am. J. Epidemiol. 2004 160:521-530; doi:10.1093/aje/kwh26

15. van Buul, J. D. et al. Arterioscler Thromb Vasc Biol 2004;24:824-833 Schematic overview of the distinct steps that comprise leukocyte transendothelial migration

16. Cardiovascular Health Risk Factors Rescue Factors HDL cholesterol Anti oxidant reserves Endothelial progenitor cells Cigarette smoking Diabetes Mellitus Hypercholesterolemia Hypertension Obesity Age Family history of CVD Gender Postprandial Hyperglycemia

17. Risk factors Apoptosis Regeneration EPC Endothelial cell apoptosis and -regeneration

18. The biological significance of EPCs What they are? The biological significance of EPCs What they are? Fadini et al, Diabetes Care 2007

19. The clinical significance of EPCs Disease Marker – Cardiovascular risk The clinical significance of EPCs Disease Marker – Cardiovascular risk Fadini et al. Eur Heart J 2006 Fadini et al. ATVB 2006

20. The clinical significance of EPCs Disease Marker – Pulmonary diseases The clinical significance of EPCs Disease Marker – Pulmonary diseases Fadini et al. Stem Cells 2006 COPD RLD

21. The clinical significance of EPCs Disease Marker – CVD vs Pulmonary disease The clinical significance of EPCs Disease Marker – CVD vs Pulmonary disease Fadini et al. AJRCMB 2006

22. Fadini et al. Eur Respir J. 2010