(Microsoft PowerPoint - S13-3_\261\350\273\363\307\366 [\310\243\310\257 \270\360\265\345])

Size: px

Start display at page:

Download "(Microsoft PowerPoint - S13-3_\261\350\273\363\307\366 [\310\243\310\257 \270\360\265\345])"

혜라 석
5 years ago
Views:

1 Cardiovascular Disease in Metabolic Syndrome 김상현 보라매병원내과 서울대학교의과대학내과학교실

2 Contents Metabolic syndrome and Cardiovascular system CVD Mortality Coronary artery disease Heart failure Atrial fibrillation Management

3 Mechanisms linking Obesity with cardiovascular disease Nature 2006;444(7121):875-80

4 Contents Metabolic syndrome and Cardiovascular system CVD Mortality Coronary artery disease Heart failure Atrial fibrillation Management

5 Mőnster Heart Study (PROCAM) P<0.001 Schulte H et al. Atherosclerosis 1999;144:

6 Mőnster Heart Study (PROCAM) Schulte H et al. Atherosclerosis 1999;144:

7 IHD, CVD and total mortality in US NHANES II Follow-Up Study (n=6,255, mean follow-up 13.3 years Age, gender, and risk-factor adjusted Malik S et al. Circulation 2004;110:

8 CHD, CVD, total mortality rates in US adults NHANES II Follow-Up Study (n=6,255, mean follow-up 13.3 years Age, gender, and risk-factor adjusted Malik S et al. Circulation 2004;110:

9 Prevalence and Progression of Metabolic Syndrome Framingham offspring study (n=3,078) Franco OH et al. Circulation 2009;120:

10 CVD, total mortality rates in Metabolic Syndrome Framingham offspring study (n=3,078) Franco OH et al. Circulation 2009;120:

11 Contents Metabolic syndrome and Cardiovascular system CVD Mortality Coronary artery disease Heart failure Atrial fibrillation Management

12 Metabolic syndrome and 11-year risk of CVD risk - Hazard ratio of CHD ARIC (Atherosclerosis Risk in Communities) study, n=12,089 Mcneill AM et al. Diabetes Care 2005;28:

13 Metabolic Syndrome and Total and Cardiovascular Disease Mortality in Middle-aged Men Kuopio Ischaemic Heart Disease Risk Factor Study, 1209 Finnish men aged 42 to 60 years ( ) Malik S et al. Circulation 2004;110:

14 Metabolic Syndrome and Risk of Cardiovascular Events After Myocardial Infarction 11,323 patients with prior MI enrolled in the GISSI-Prevenzione Trial Malik S et al. Circulation 2004;110:

15 Predicting diabetes and CVD using the metabolic syndrome, Diabetes Risk Score, and Framingham Risk Score 1,709 initially nondiabetic San Antonio Heart Study (SAHS) participants for 7.5 years 1,353 initially nondiabetic Mexico City Diabetes Study (MCDS) participants for 6.5 years Stern MP et al. Diabetes Care 2004;27(11):2676-3

16 Hypertension in Metabolic syndrome Insulin resistance -> hyperinsulinemia, obesity Sympathetic system activation RAS activation Fluid overload with increased Na reabsorption Vasoconstriction Increased sensitivity to salt Change of Vessel wall composition Increased smooth muscle cells Glycoylation and increased stiffness; Interstitial tissue Decreased NO production Decreased endothelial function ; ROS, inflammation

17 Prevalence of metabolic syndrome by BP stage and subtype Franklin SS et al. J Hypertension 2006;24:

18 Contents Metabolic syndrome and Cardiovascular system CVD Mortality Coronary artery disease Heart failure Atrial fibrillation Management

19 Age-Adjusted Hospitalization Rates for HF in US National Hospital Discharge Survey Fang J et al. J Am Coll Cardiol 2008;52:428-34

20 Cumulative Incidence of Heart Failure According to BMI Kenchaiah S. N Engl J Med 2009;119:44-52

components 550 non-diabetic patients (275 without Met Syn, 275 with

21 Impact of metabolic syndrome on LV myocardial performance (Tei index) Without or with metabolic syndrome Without or with 3 to 5 met syn components 550 non-diabetic patients (275 without Met Syn, 275 with Met Syn) Voulgari C et al. Diabetes Metab Res Rev 2010;26:

22 Pathogenesis of Heart Failure in Metabolic disease

23 Cumulative incidence of heart failure total cohort of Patients (n=2314) older than 50 years free from heart failure, MI and valvular disease at baseline by the presence or absence of metabolic syndrome since 1970 Ingelsson E et al. Heart 2006;92:

24 Contents Metabolic syndrome and Cardiovascular system CVD Mortality Coronary artery disease Heart failure Atrial fibrillation Management

25 Metabolic Syndrome and Development of Atrial Fibrillation Niigata Preventive Medicine Study, n=28,449, prospective, community-based, observational cohort study Watanabe H et al. Circulation 2008;117:

25 BMI<30 mild obesity 30 BMI<35, moderate severe

26 Incidence of postoperative atrial fibrillation according to BMI Normal weight: BMI <25, overweight: 25 BMI<30 mild obesity 30 BMI<35, moderate severe obesity: BMI 35 Echahidi N et al. Circulation 2007;116:I

27 Contents Metabolic syndrome and Cardiovascular system CVD Mortality Coronary artery disease Heart failure Atrial fibrillation Management

28 Screening of atherosclerosis

29 Carotid intima-media thickness

30 Coronary calcium in CT

31 Epicardial fat thickness and CVD prediction

32 Management Therapeutic Lifestyle Change body weight management Exercise Dietary control Control ; progression to diabetes Blood pressure control : ACEI, ARB Dyslipidemia management : statin, fibrate, nicotinic acid PPAR-alpha, gamma agonist Collagen linkage breaker Others

33 Proportion of IHD events potentially preventable Proportion of IHD events potentially preventable from optimal control of BP, LDL-C and HDL-C in men and women Wong ND et al. Am J Cariol 2003;91:1421-6

34 Conclusion Metabolic syndrome is important portion of cardiometabolic disease spectrum. ; atherosclerosis, cardiac function, arrhythmia, vascular function Additive information and value about CVD ; prediction for incident cardiovascular disease Management of obesity and metabolic risk factors Therapeutic life style change and drug treatment for the prevention of cardiovascular disease

35 35

36 CHD, CVD, total mortality rates in US adults NHANES II Follow-Up Study (n=6,255, mean follow-up 13.3 years P<0.05 Age, gender, and risk-factor adjusted Malik S et al. Circulation 2004;110:

37 CHD, CVD, total mortality rates in US adults NHANES II Follow-Up Study (n=6,255, mean follow-up 13.3 years Malik S et al. Circulation 2004;110:

38 Metabolic Syndrome and Risk of Cardiovascular Events After Myocardial Infarction Malik Levantesi G et al. JACC 2005;46:

39 Mőnster Heart Study (PROCAM) Schulte H et al. Atherosclerosis 1999;144:

저작자표시 - 비영리 - 변경금지 2.0 대한민국 이용자는아래의조건을따르는경우에한하여자유롭게 이저작물을복제, 배포, 전송, 전시, 공연및방송할수있습니다. 다음과같은조건을따라야합니다 : 저작자표시. 귀하는원저작자를표시하여야합니다. 비영리. 귀하는이저작물을영리목적으로이용할

저작자표시 - 비영리 - 변경금지 2.0 대한민국 이용자는아래의조건을따르는경우에한하여자유롭게 이저작물을복제, 배포, 전송, 전시, 공연및방송할수있습니다. 다음과같은조건을따라야합니다 : 저작자표시. 귀하는원저작자를표시하여야합니다. 비영리. 귀하는이저작물을영리목적으로이용할수없습니다. 변경금지. 귀하는이저작물을개작, 변형또는가공할수없습니다. 귀하는, 이저작물의재이용이나배포의경우,