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- July 20, 2008 |
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"CVD Risk in the Metabolic Syndrome"Dr. Richard W. Nesto (biography)
English - 2005-04-15 - 34 minutes
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Summary :
In this presentation Dr. Nesto gives a general overview of CVD risk in the metabolic syndrome, and discusses specific features of the metabolic syndrome that are strongly associated with risk.
In the U.S. National Health and Nutrition Examination Survey III (NHANES III), metabolic syndrome was associated with history of myocardial infarction and stroke (1), and in NHANES II it was found that CHD, CVD and total mortality were more strongly predicted by the metabolic syndrome than its individual components (2). In NHANES III and other studies, low HDL and high TG levels emerged as strong predictors of risk among the components of the metabolic syndrome (1,3,4). With regards to the prediabetic state, the Nurses' Health Study found an increased risk of CVD even before the diagnosis of diabetes in women (5).
In patients with untreated hypertension, metabolic syndrome has been associated with increased left ventricular hypertrophy and left ventricular concentric remodeling (6). These and other factors demonstrate how hypertension is a stronger CV risk factor in the setting of insulin resistance.
Dr. Nesto ends his presentation with a discussion of C-reactive protein levels, metabolic syndrome and cardiovascular risk (7), and a recap of characteristics that can be found in the metabolic syndrome patient at high risk for CVD.
Copyright © 2005 E-MedHosting.com Inc.
Learning objectives :
After viewing this presentation the participant will be able to discuss:
- Increased risk of CHD, CVD and total mortality with the metabolic syndrome
- The importance of high TG and low HDL as determinants of CV risk in the metabolic syndrome
- Hypertension as a more powerful predictor of CV risk in the setting of insulin resistance
- C-reactive protein, metabolic syndrome and CV risk
- Features of high-risk metabolic syndrome patients
Bibliographic references :
1. John K. Ninomiya, MSc; Gilbert L’Italien, PhD; Michael H. Criqui, MD, MPH; Joanna L. Whyte, MS, RD, MSPH; Anthony Gamst, PhD; Roland S. Chen, MD. Association of the Metabolic Syndrome With History of Myocardial Infarction and Stroke in the Third National Health and Nutrition Examination Survey Circulation. 2004;109:42-46.
2. Shaista Malik, MD, MPH; Nathan D. Wong, PhD, MPH; Stanley S. Franklin, MD; Tripthi V. Kamath, PhD; Gilbert J. L’Italien, PhD; Jose R. Pio, BS; G. Rhys Williams, ScD. Impact of the Metabolic Syndrome on Mortality From Coronary Heart Disease, Cardiovascular Disease, and All Causes in United States Adults Circulation. 2004;110:1245-1250.
3. Jørgen Jeppesen, MD; Hans Ole Hein, MD; Poul Suadicani, DD; Finn Gyntelberg, MD. Low Triglycerides–High High-Density Lipoprotein Cholesterol and Risk of Ischemic Heart Disease Arch Intern Med. 2001;161:361-366.
4. Giuseppe Schillaci, Matteo Pirro, Gaetano Vaudo, Fabio Gemelli, Simona Marchesi, Carlo Porcellati and Elmo Mannarino Prognostic value of the metabolic syndrome in essential hypertensionJACC. 19 May 2004, Volume 43, Issue 10 Pages 1817-1822.
5. Frank B. Hu, MD, Meir J. Stampfer, MD, Steven M. Haffner, MD, Caren G. Solomon, MD, Walter C. Willett, MD and JoAnn E. Manson. Impact of the Metabolic Syndrome on Mortality From Coronary Heart Disease, Cardiovascular Disease, and All Causes in United States Adults Diabetes Care 25:1129-1134, 2002.
6. Cuspidi, Cesare; Meani, Stefano; Fusi, Veronica; Severgnini, Barbara; Valerio, Cristiana; Catini, Eleonora; Leonetti, Gastone; Magrini, Fabio; Zanchetti, Alberto. Metabolic syndrome and target organ damage in untreated essential hypertensives.Journal of Hypertension. 22(10):1991-1998, October 2004.
7. Martin K. Rutter, MD; James B. Meigs, MD, MPH; Lisa M. Sullivan, PhD; Ralph B. D’Agostino, Sr, PhD; Peter W.F. Wilson, MD. C-Reactive Protein, the Metabolic Syndrome, and Prediction of Cardiovascular Events in the Framingham Offspring Study Circulation. 2004;110:380-385.
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