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Metabolic syndrome from a gender and cardiovascular perspective Eva Swahn
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IDF Worldwide Definition of the Metabolic Syndrome (2005) The metabolic syndrome is a cluster of the most dangerous heart attack risk factors: diabetes and prediabetes, abdominal obesity, high cholesterol and high blood pressure. A quarter of the world’s adults have metabolic syndrome People with metabolic syndrome are twice as likely to die from, and three times as likely to have a heart attack or stroke compared with people without the syndrome People with metabolic syndrome have a five-fold greater risk of developing type 2 diabetes Up to 80% of the 200 million people with diabetes globally will die of cardiovascular disease
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Cardiovascular disease Classical Risk Factors Novel Risk Factors Metabolic syndrome T2DM Smoking LDL-C BP Abdominal Obesity HDL-C TG TNF IL-6 PAI-1 Glu Insulin Cancer
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Definition Waist in cm Women >80 obs Women >88 action Men >94 obs Men >102 action Prevention of coronary heart disease in clinical practice. Eur Heart Journal 1998;19:1434-1503 Waist in cm Women >8069% Women >88 42% Men >94 64% Men >102 32% Waist in cm Women >8069% Women >88 42% Men >94 64% Men >102 32% Abdominal obesity in Stockholm people (60 years old)
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Health threat from abdominal obesity is largely due to intra-abdominal obesity Abdominal Obesity Dyslipidemia Hypertension Glucose Intolerance Insulin Resistance Increased Cardiometabolic Risk Intra-Abdominal Adiposity Adapted from Eckel et al 2005
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Nurses Health Study, 88 393 women, 34-59 years followed for 20 years, 1980-2000, healthy at study start. Risk to get heart disease Abdominal obesity Overweight The importance of abdominal obesity on the risk to get myocardial infarction Tricia Y.Li et al. Circulation 2006;113:499-506
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Copenhagen city heart study EHJ (2002) 23, 620-626
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Smoking Diabetes Psycosocial factors High lipids Food AlcoholHigh bloodpressure Overweight Abdominal obesity Thrombogenic factors coagulation / fibrinolysis Physical activity HeredityInfection Inflammation Interheart Yusuf S et al, Lancet 2004;364:937-52
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3.6 mmol/l 0.8 g/l 3.6 mmol/l 1.5 g/l LDL apoB apo B Large buoyantSmall dense © G.Walldius, I. Jungner
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Interheart Odds ratio for myocardial infarction depending on quintiles for apoB/apoA-I (after adjusting for other risk factors). Yussuf S et al, Lancet -04 OR apoB/apoA-I
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apoB and LDL – relation to sex
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Oldfashioned mediterranean food
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MooreLess
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Levine JA et al. Am J Clin Nutr 2000;72:1451 Energy use kJ/min
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One cigarette shortens life with 2 min. One beer shortens life with 4 min. One working day shortens life with 8 hours!!!
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