Managing cardiometabolic risk
This presentation is the property of its rightful owner.
Sponsored Links
1 / 24

Managing Cardiometabolic Risk PowerPoint PPT Presentation


  • 99 Views
  • Uploaded on
  • Presentation posted in: General

Managing Cardiometabolic Risk. Lifestyle modification and weight reduction strategies. NHLBI guidelines: Adiposity assessment. Use BMI to assess body fat Body weight alone can be used to track weight loss, and to determine efficacy of therapy (Evidence Category C)

Download Presentation

Managing Cardiometabolic Risk

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


Managing cardiometabolic risk

Managing Cardiometabolic Risk

Lifestyle modification and weight reduction strategies


Nhlbi guidelines adiposity assessment

NHLBI guidelines: Adiposity assessment

  • Use BMI to assess body fat

    • Body weight alone can be used to track weight loss, and to determine efficacy of therapy(Evidence Category C)

  • Use BMI to classify overweight/obesity

    • Estimate relative risk of disease compared to normal weight (Evidence Category C)

  • Use waist circumference to assess abdominal fat content (Evidence Category C)

NHLBI. www.nhlbi.nih.gov.


Bmi classifications

BMI classifications

NHLBI. www.nhlbi.nih.gov.


Measuring waist circumference

Locate upper hip bone and top of right iliac crest

Place measuring tape horizontally around abdomen at level of iliac crest

Tape should be snug without causing compression

Measuring waist circumference

Iliac crest

NHLBI. www.nhlbi.nih.gov.


Diagnostic criteria for metabolic syndrome

Diagnostic criteria for metabolic syndrome

Any 3 criteria

Adiposity

Dyslipidemia

HDL-C <40 mg/dL (men)

HDL-C <50 mg/dL (women)

TG ≥150 mg/dL

WC (men)≥35 (Asian)≥40 (other ethnicities)

WC (women)≥31 (Asian)≥35 (other ethnicities)

Dysglycemia

Hypertension

BP ≥130/85 mm Hg

FG ≥100 mg/dL

WC = waist circumference (inches)

Grundy SM. J Am Coll Cardiol. 2006;47:1093-100.


Nhlbi guidelines weight loss goals

NHLBI guidelines: Weight loss goals

  • Goal is ~10% reduction from baseline weight (Evidence Category A)

  • If successful, assess continued weight loss (Evidence Category A)

  • Aim for weight loss ~1–2 lb/week for 6 months

    • Base subsequent strategies on the amount of weight lost (Evidence Category B)

NHLBI. www.nhlbi.nih.gov.


Guide to adiposity management

Guide to adiposity management

NHLBI. www.nhlbi.nih.gov.Lee M, Aronne LJ. Am J Cardiol. 2007;99(suppl):68B-79B.


Nhlbi guidelines lifestyle modification

NHLBI guidelines: Lifestyle modification

  • Combined intervention of a calorie-deficit diet, physical activity, and behavioral treatment is most successful for weight loss and maintenance(Evidence Category A)

    • 500-1000 kcal/day deficit

    • Moderate physical activity 30-45 min, 3-5 days/week, with eventual goal of ≥30 min on most (and preferably all) days of the week

  • Maintain for ≥6 months before considering pharmacotherapy

NHLBI. www.nhlbi.nih.gov.


Some moderate intensity physical activities

Some moderate-intensity physical activities

Moderate activity  150 calories of energy per day

NHLBI. www.nhlbi.nih.gov.


3 week diet exercise regimen yields favorable metabolic changes

3-Week diet + exercise regimen yields favorable metabolic changes

N = 31 overweight/obese men; weight 8.4 lbs

μU/mL

Baseline

Follow-up

*P < 0.01

†P < 0.05

Roberts CK et al. J Appl Physiol. 2006;100:1657-65.


Physical activity may reduce cv and all cause mortality

Physical activity may reduce CV and all-cause mortality

N = 9791; moderate physical activity vs little or no physical activity

Adjusted HR (95% CI)

Favorsexercise

Favorsno exercise

Normal BP

All-cause death

0.75 (0.53–1.05)

CV death

0.76 (0.39–1.49)

Prehypertension

All-cause death

0.79 (0.65–0.97)

CV death

0.79 (0.58–1.09)

Hypertension

All-cause death

0.88 (0.80–0.98)

CV death

0.84 (0.73–0.97)

0.5

1.0

1.5

0

2.0

Hazard ratio

NHANES 1 Epidemiological Follow-up Survey (1971–1992)

Fang J et al. Am J Hypertens. 2005;18:751-8.


Lifestyle modification associated with diabetes prevention

Lifestyle modification associated with diabetes prevention

Meta-analysis of 5 randomized, controlled trials

Pan et al, 1997

Wein et al, 1999

Tuomilehto et al, 2001

DPPRG, 2002

Watanabe et al, 2003

Combined: Fixed

Combined: Random

Combined: Bayesian

0.1

0.5

1.0

5.0

10.0

Relative risk (95% CI)

Yamaoka K, Tango T. Diabetes Care. 2005;28:2780-6.


Dpp benefit of diet exercise or metformin on diabetes prevention in at risk patients

DPP: Benefit of diet + exercise or metformin on diabetes prevention in at-risk patients

N = 3234 with IFG and IGT without diabetes

40

Placebo

P*

30

Metformin

<0.001

31%

Cumulative

incidence of diabetes

(%)

20

Lifestyle†

<0.001

58%

10

0

0

1

2

3

4

Year

*vs placebo (unadjusted)

†Achieve/maintain ≥7% reduction of initial body weight via diet + moderate-intensity physical activity ≥150 minutes/week

DPP Research Group. N Engl J Med. 2002;346:393-403.


Popular dietary programs effective yet difficult to maintain

Popular dietary programs: Effective yet difficult to maintain

N = 160 overweight or obese with ≥1 CV risk factor

Dansinger ML et al. JAMA. 2005;293:43-53.


Look ahead study design

Look AHEAD: Study design

Look Action for Health in Diabetes

N = 5145

45-74 years with T2DM, BMI ≥25 kg/m2 (≥27 kg/m2 if taking insulin)

Usual medical care + diabetes support and education for 4 years

Usual medical care+ lifestyle intervention* for 4 years, with maintenance counseling thereafter

Total follow-up 11.5 years

Primary endpoint: CV death, nonfatal MI, nonfatal stroke

*≥7% mean weight loss with hypocaloric diet ± pharmacologic therapy+≥175 min/week moderate physical activity Diet = 1200-1500 kcal/day (<250 lbs) or1500-1800 kcal/day (≥250 lbs)

Look AHEAD Research Group. Control Clin Trials. 2003;24:610-28; Obesity. 2006;14:737-52.


Nhlbi guidelines pharmacologic therapy

NHLBI guidelines: Pharmacologic therapy

  • FDA-approved drugs may be used as part of a comprehensive weight-loss program, including dietary therapy and physical activity (Evidence Category B) in these individuals:

    • BMI ≥30 kg/m2 with no concomitant risk factors or diseases

    • BMI ≥27 kg/m2 with concomitant risk factors or diseases (hypertension, dyslipidemia, CHD, T2DM, sleep apnea)

  • Herbal preparations are not recommended. These preparations have unpredictable amounts of active ingredients and unpredictable, and potentially harmful, effects.

NHLBI. www.nhlbi.nih.gov.


Pharmacologic weight management options

Pharmacologic weight management options

*Available Rx and OTC (1/2 dose)

†Placebo-corrected

NE = norepinephrine

Arterburn DE et al. Arch Intern Med. 2004;164:994-1003. Li Z et al. Ann Intern Med. 2005;142:532-46.


Efficacy of orlistat as adjunct to lifestyle modification

Efficacy of orlistat as adjunct to lifestyle modification

N = 3305, mean BMI 37 kg/m2

0

-3.0 kg

-3

P < 0.001

Δ Body weight(kg)

-5.8 kg

-6

-9

-12

0

52

104

156

208

Weeks

Placebo + lifestyle

Orlistat + lifestyle

All subjects prescribed a reduced-calorie diet (~800 kcal/day deficit) and encouraged tophysical activity

Torgerson JS et al. Diabetes Care. 2004;27:155-61.


Efficacy of sibutramine as adjunct to lifestyle modification

Efficacy of sibutramine as adjunct to lifestyle modification

0

2

4

Sibutramine alone

6

Lifestyle modification alone

Weight loss (kg)

Sibutramine + brief therapy

8

10

Combined therapy

12

14

16

0

3

6

10

18

40

52

Weeks

N = 224 with obesity, mean BMI 38 kg/m2

All subjects prescribed balanced 1200-1500 kcal/day diet and encouraged to walk 30 min/day

Wadden TA et al. N Engl J Med. 2005;353:2111-20.


Effects of sibutramine and lifestyle modification on cardiometabolic risk factors

Effects of sibutramine and lifestyle modification on cardiometabolic risk factors

Change from baseline at 1 year

Wadden TA et al. N Engl J Med. 2005;353:2111-20.


Scout study design

SCOUT: Study design

Sibutramine Cardiovascular OUtcome Trial

N  9000

≥55 years with BMI 27–45 kg/m2 (or 25 to <27 kg/m2 + waist ≥40" men, ≥35" women) + History of CV event (or T2DM + 1 other CV risk factor)

6-week single-blind lead-in

Sibutramine 10 mg + lifestyle intervention*

Placebo + lifestyle intervention*

Sibutramine 10–15 mg + lifestyle intervention*

3-year randomized, double-blind phase

Primary endpoint: MI, stroke, resuscitated cardiac arrest, CV death

*Hypocaloric diet (-600 kcal/day) + ≥150 min/week moderate physical activity

James WPT. Eur Heart J Suppl. 2005;7(suppl L):L44-8.


Nhlbi guidelines weight loss surgery

NHLBI guidelines: Weight loss surgery

  • An option for carefully selected patients when less-invasive methods have failed and the patient is at high risk for obesity-associated morbidity or mortality (Evidence Category B)

    • BMI ≥40 kg/m2

    • BMI ≥35 kg/m2 with comorbid conditions

NHLBI. www.nhlbi.nih.gov.


Sos bariatric surgery associated improvements in cardiometabolic risk

SOS: Bariatric surgery-associated improvements in cardiometabolic risk

Conventional treatment (n = 1660)

Gastric surgery (n = 1845)

Swedish Obese Subjects (SOS) Study, N = 4047, mean BMI 41 kg/m2

*At 2 years

Sjöström L et al. N Engl J Med. 2004;351:2683-93.


Improved framingham risk score following bariatric surgery

Improved Framingham risk score following bariatric surgery

N = 109, mean BMI 49 kg/m2 (preoperative), 36 kg/m2 (13-month follow-up)

12

10

8

10-year CHD risk(%)

P = 0.002

P < 0.0001

6

4

2

Men

Women

Before surgery

After surgery

Vogel JA et al. Am J Cardiol. 2007;99:222-6.


  • Login