Rachel mclaughlin pharmd candidate university of georgia november 6 2012
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Rachel McLaughlin PharmD candidate University of Georgia November 6, 2012. Cardiometabolic Syndrome in Elderly Women. Metabolic Syndrome. ATP III defined a multiplex risk factor for cardiovascular disease (CVD) Abdominal obesity (increased waist circumference)

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Cardiometabolic Syndrome in Elderly Women

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Rachel mclaughlin pharmd candidate university of georgia november 6 2012

Rachel McLaughlin

PharmD candidate

University of Georgia

November 6, 2012

Cardiometabolic Syndrome in Elderly Women


Metabolic syndrome

Metabolic Syndrome

  • ATP III defined a multiplex risk factor for cardiovascular disease (CVD)

    • Abdominal obesity (increased waist circumference)

    • Dyslipidemia (raised TGs and low HDL)

    • Elevated blood pressure

    • Insulin resistance +/- glucose intolerance

    • Proinflammatory state (elevated CRP)

    • Prothrombotic state (elevated plasma plasminogen activator inhbitor and prothrombin)


Metabolic syndrome1

Metabolic Syndrome

  • Underlying CVD risk factors

    • Obesity, physical inactivity, atherogenic diet

  • Major risk factors

    • Cigarette smoking, hypertension, high LDL, low HDL, family history of premature CHD, aging

  • Emerging risk factors

    • High TGs, small LDL particles, insulin resistance, glucose intolerance, proinflammatory state, prothrombotic state


Metabolic syndrome2

Metabolic Syndrome

  • At least three of the following:


Metabolic syndrome3

Metabolic Syndrome


Metabolic syndrome4

Metabolic Syndrome

  • Increase in risk of CVD outcomes with increasing number of traits

  • CVD is the primary clinical outcome, but MetS also increases risk for type 2 diabetes and susceptible to polycystic ovary disease, fatty liver, cholesterol gallstones, asthma, sleep disturbances and some cancers


Cardiometabolic syndrome in elderly women

Age- and sex-specific prevalence and ten-yearrisk for cardiovascular disease of all 16 risk factorcombinations of the metabolic syndrome -A cross-sectional studyCardiovascular Diabetology, August 2010


Methods

Methods

  • German Metabolic and Cardiovascular Risk Project (GEMCAS) data from 2005

    • 35,869 participants

    • Ages 18-99, 61% women

  • Physicians recorded DM and CVD histories and assessed MetS risk factors according to a standardized assessment

  • Analyzed all 16 combinations of MetS risk factors association with 10-year risk of fatal and nonfatal MI

  • Calculated age-standardized prevalence rates to compare CV comorbidities prevalence with different combinations


Results

Results


Results1

Results

  • Most frequent combination in both men and women: WC-BP-GL

  • More frequent in women than men: WC-HDL-BP

    • 10% vs 3%

  • In women, the 8 combinations with highest prevalence all included BP and 5 out of 8 included WC


Results2

Results

  • PROCAM analysis of 10-year risk for MI

    • Much higher in men than women

    • Women without MetS: 1.2% ; with: 2.3%

    • Highest risk combos for women: TG-HDL-BP-GL, WC-TG-HDL-BP, and all five traits combined

  • ESC score: 10-year risk of fatal MI

    • Women without MetS: 1.2% ; with: 1.8%

    • Highest risk combos for women: TG-HDL-BP-GL, WC-TG-HDL-BP


Discussion

Discussion

  • There was a substantial influence of age and gender on the prevalence of combinations

    • Every GL combo more prevalent in elderly

    • Higher rates of WC in women

  • Each combination of MetS may not uniformly increase CV risk

    • HDL and BP frequent in high risk groups

    • Treat these as higher risk factors than the others??


Cardiometabolic syndrome in elderly women

Body composition and its association with cardiometabolic risk factors in the elderly: A focus on sarcopenic obesityArchives of Gerontology and Geriatrics: September 2012


Methods1

Methods

  • 2943 Korean subjects 60 years or older

  • Body composition categorized into four groups: sarcopenic obese, sarcopenic nonobese, nonsarcopenic obese, and nonsarcopenic nonobese

    • Sarcopenia = appendicular skeletal muscle mass divided by weight <1 SD below the mean for young adults

    • Obesity = BMI >25 kg/m2

  • Measured cardiometabolic risk factors

    • BP, glucose intolerance, lipid profiles, inflammatory markers, vitamin D level


Results3

Results

  • Sarcopenic obese group had most insulin resistance, metabolic syndrome, and CVD risk factors

  • Lowest HDL and vitamin D levels in the sarcopenic obese group

  • BP, glucose, lipid profiles -risk factors for CVD- significantly associated with the obese subjects


Discussion1

Discussion

  • Skeletal muscle is a primary tissue responsible for insulin-mediated glucose disposal so muscle loss causes diminished glucose disposal

  • High fat mass secretes proinflammatory adipocytokines

  • We need to focus on both obesity and muscle loss


What do we do

What do we do?

  • Obesity

    • ATP III recommends tackling this first: lowers cholesterol, raises HDL, lowers blood pressure and glucose

    • Lose 10% of body weight

    • Reinforce with physical activity... help with sarcopenia

  • Insulin resistance

  • Blood pressure

  • Lipids

    • Several drugs will also lower CRP levels


Cardiometabolic syndrome in elderly women

  • For women, especially look at waist circumference, low HDL, high triglycerides and blood pressure as these caused the highest CV risk in elderly women

  • As people age, look carefully for signs of insulin resistance and treat appropriately

  • Exercise!


References

References

  • Chung, Ji-Youn, Hee-Taik Kang, Duk-Chul Lee, Hye-Ree Lee, Yong-Jae Lee. Body composition and its association with cardiometabolic risk factors in the elderly: A focus on sarcopenic obesity. Archives of Gerontology and Geriatrics. September 2012.

  • Grundy, Scott, Brewer, Jr,H. Bryan, Cleeman, James, Smith, Jr, Sidney, and Lenfant, Claude. Definition of Metabolic Syndrome: Report of the National Heart, Lung, and Blood Institute/ American Heart Association Conference on Scientific Issues Related to Definition. Circulation. 2004; 109:433-438.

  • Moebus, Susanne, Balijepalli, Chakrapani, Lösch Christian, Laura Göres, Bernd von Stritzky, Bramlage, Peter, Jürgen Wasem, Karl-Heinz Jöckell. Age- and sex-specific prevalence and ten-year risk for cardiovascular disease of all 16 risk factor combinations of the metabolic syndrome - A cross-sectional study. Cardiovascular Diabetology. 2010: 9:34.


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