Metabolic syndrome from a gender and cardiovascular perspective

Metabolic syndrome from a gender and cardiovascular perspective Eva Swahn

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 • Up to 80% of the 200 million people with diabetes globally will die of cardiovascular disease • 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

Novel Risk Factors Classical Risk Factors Metabolic syndrome LDL-C BP Smoking HDL-C TNF IL-6 Insulin Abdominal Obesity Glu PAI-1 TG Cardiovascular disease T 2 DM Cancer

Abdominal obesity in Stockholm people (60 years old) 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 >80 Women >88 69% 42% Men >94 Men >102 64% 32%

Health threat from abdominal obesity is largely due to intra-abdominal obesity Increased Cardiometabolic Risk Dyslipidemia Hypertension Abdominal Obesity Intra-Abdominal Adiposity Adapted from Eckel et al 2005 Glucose Intolerance Insulin Resistance

The importance of abdominal obesity on the risk to get myocardial infarction 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 Tricia Y. Li et al. Circulation 2006; 113: 499 -506

Copenhagen city heart study EHJ (2002) 23, 620 -626

Interheart High lipids Food Diabetes Physical activity Psycosocial factors Alcohol High bloodpressure Overweight Abdominal obesity Smoking Heredity Infection Inflammation Thrombogenic factors coagulation / fibrinolysis Yusuf S et al, Lancet 2004; 364: 937 -52

Moore Less

Energy use k. J/min Levine JA et al. Am J Clin Nutr 2000; 72: 1451

One cigarette shortens life with 2 min. One beer shortens life with 4 min. One working day shortens life with 8 hours!!!