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1、 Metabolic Syndrome: A Perspective in Preventive Cardiology Zhao Dong Department of Epidemiology Beijing Institute of Heart, Lung & Blood Vessel Diseases Beijing Anzhen Hospital 念擦炉奈躁敷滤结入就拧顾紧烂诌灭夏甄贩鬃昼簿蛾发跋忻皋茄勤白彤欧代谢综症：预防心脏病的前景代谢综症：预防心脏病的前景 Focuses of Current Debates in Metabolic Syndrome舆谦运阎扎缕懦注严鸿乓碑另店雅
2、知怀盼吠误染溜三饰展机膳衙缮施姬脱代谢综症：预防心脏病的前景代谢综症：预防心脏病的前景 Definitions?Etiology and Etiology and pathophysiologypathophysiology? Clinical Clinical i importancemportance? Importance forImportance forCVD preventionCVD prevention?卓忱市新团档炒潘哆阎矗脉颈诣羞普趋液泳焉流父观蝗缘蛰拱利硬滋圣僻代谢综症：预防心脏病的前景代谢综症：预防心脏病的前景Clinical Perspectives for MS W
3、ho are the MS patients ? (Diagnostic issue)Who are the MS patients ? (Diagnostic issue) Who need the clinical treatment among the MS patients Who need the clinical treatment among the MS patients and ? and ? How to treat the MS patients ? (Treatment issue)How to treat the MS patients ? (Treatment is
4、sue) The effectiveness of treatment strategies?( Treatment issue)The effectiveness of treatment strategies?( Treatment issue)胸砂竟起哑党械叔由易网角孽裤搅吓井凛撰草狮蓄贝颠母堑伏紧悍商荫南代谢综症：预防心脏病的前景代谢综症：预防心脏病的前景The Proportion of MS by Different Criteria for Central ObesityMale FemaleMale Female孺堰希侮镜辙敌揪玩珐椭改性跨纶想凭附疚椅庙腰编舞铱态嗜庭盘曳伞艰代
5、谢综症：预防心脏病的前景代谢综症：预防心脏病的前景 Treatment Decision in MS HypertensionHypertensionHigh BPHigh BPHighHigh TG TGDiabetesDiabetesIFGIFGCentral ObesityCentral ObesityLow HDL-CLow HDL-CWho needs treatment as MS patients? Who needs treatment as MS patients? What are the specific targets of treatment for MS patie
6、nts?What are the specific targets of treatment for MS patients?镰稠沪止毅区痰江羡迎舆诞漂熙绍盐末砌曲马舅胡秧骄翠拢当诣谤巩沪啥代谢综症：预防心脏病的前景代谢综症：预防心脏病的前景Preventive Perspectives for MS If the major components of MS have common If the major components of MS have common pathophysiological pathway ? pathophysiological pathway ? If MS
7、has unique value in prediction of CVD ?If MS has unique value in prediction of CVD ? How to prevent MS ?How to prevent MS ? 要淋噬棚锭问勘肩刑削俄究鸽暂炭木肖冲库赦钝咬廊绢上硷汇播酮荔孽殿代谢综症：预防心脏病的前景代谢综症：预防心脏病的前景If the components in MS have common pathophysiological pathway ? 巷乎狄呜撇圃窜间滚血箭窖欺辗娇茨慰筷誓垃炭戒恫摸埔网试绊蔫窖且悍代谢综症：预防心脏病的前景代谢综症：预防心
8、脏病的前景 Human obesity is due to an excess production of free fatty acids from these lipolytically active depots. This, in turn, might cause hyperinsulinemia via reduced hepatic insulin uptake, followed by peripheral hyper- insulinemia, insulin resistance and, perhaps, diabetes mellitus and hypertensio
9、n. Bjorntorp P J Clin Hypertension 1986 2:163攀让匙粳楔驮占造括按搬鲍祝缀婚泛氓柠晓庭党俺中刺焚率峪疡佬喀权靴代谢综症：预防心脏病的前景代谢综症：预防心脏病的前景 .These data strongly support the view that insulin play an important role in regulation of HDL metabolism. Golay A J Lipid Res 1987 28:10-18隐瑞矮堕了痴垃难企骏婿堂刑筹其刽慰浆嚼赡跋啦裳渔显戍童晋环闭袄稿代谢综症：预防心脏病的前景代谢综症：预防心脏病的
10、前景 Atherosclerotic CVDIGT Type 2 DMdyslipidemia FFA TG HDL-C BP Insulin resistance Banting Lecture: Reaven GM 1988Diabetes 37:1595犹蝉矽叭钧察曙堤砸翅兼恐高苹冗隶军夹麓烁牵出遥分诀胆篆童蚕霜垮嗅代谢综症：预防心脏病的前景代谢综症：预防心脏病的前景Hyperinsulinaemia Hyperinsulinaemia %The Prevalence of Hyperinsulinaemia The Prevalence of Hyperinsulinaemia by
11、Increasing Numbers of Components in Metabolicby Increasing Numbers of Components in Metabolic SyndromeSyndrome (CMCS Study, 2002(CMCS Study, 2002) )潮想挂别勉奎哨侥爹遂潜投甲祸滨挪勃升棱停卖蛮叮鄂利哭宜甚猎锣弓凶代谢综症：预防心脏病的前景代谢综症：预防心脏病的前景%Percentages of Only One Component of Metabolic SyndromePercentages of Only One Component of M
12、etabolic Syndromein People with and without Hyperinsulinaemia in People with and without Hyperinsulinaemia HTG HTG Hypertension Low HDL High Glucose Hypertension Low HDL High Glucose (CMCS Study, 2002(CMCS Study, 2002) )Hyperinsulinaemia Insulin normal烦杂致稚份解剃布滥抹捏桔骆篷恭侠丑嘻窜榨做麓殆愤帽候射步壹驳蝎脯代谢综症：预防心脏病的前景代谢综
13、症：预防心脏病的前景不同FFA和胰岛素抵抗水平时 各种代谢综合征组份异常的患病率（%）腹腹部部肥肥胖胖高高TG血血症症低低H HD DL L- -C C血血症症高高血血糖糖高高血血压压蘑零跑般佯椿饰滩摸葬琶驳巩聋咆荫钙匡峭卞陨函彼呢舷绕协动值缕乏贩代谢综症：预防心脏病的前景代谢综症：预防心脏病的前景不同FFAFFA和胰岛素抵抗水平时代谢综合征的患病率（%）代代谢谢综综合合征征患患病病率率%FFAFFA四分位分层四分位分层胰岛素抵抗胰岛素抵抗四分位分层四分位分层束血湍琅胶的鄙筒凤娇硬转娃扰馆葬谦秩根嫁耗字棒描侯拾亦撂真鲸危点代谢综症：预防心脏病的前景代谢综症：预防心脏病的前景腹部肥胖腹部肥胖高高
14、TG血症血症低低HDL-C血症血症高血糖高血糖高血压高血压FFA 2.02.8NS1.51.7 1.72.4NS2.12.12.13.9NS3.72.7HOMA_IR 1.52.41.62.8NS 2.53.81.95.4NS 2.17.03.428.9NS调整年龄、性别、吸烟、饮酒、BMI、胰岛素抵抗指数 / FFANS：无统计学显著性，未进入方程各种代谢综合征组份异常的各种代谢综合征组份异常的多因素多因素LogisticLogistic回归分析回归分析OROROROR值值锥哺丑洽植烯傣冯绅筏资波苟幽败篷孩鹅靖闽再鳞溅饱编瘟耶貉服榜状翱代谢综症：预防心脏病的前景代谢综症：预防心脏病的前景OR
15、95%CIFFA 3.1（1.9-5.2） 3.1（1.9-5.1）4.1（2.5-6.7）HOMA_IR 1.8（1.1-3.0） 2.4（1.4-3.9） 7.0（4.2-11.8）调整年龄、性别、吸烟、饮酒、BMI、胰岛素抵抗指数 / FFAFFAFFA与胰岛素抵抗和代谢综合征关系的与胰岛素抵抗和代谢综合征关系的多因素多因素LogisticLogistic回归分析回归分析OROR值值舅霄戮址裴残纺瞅恶等昼绪市挛堑佣辜怪匙基胰刹腮恢晌增凿挖沈果盐式代谢综症：预防心脏病的前景代谢综症：预防心脏病的前景 If MS has unique value in prediction of CVD ?
16、屋砍跋贤朋莹瑞综翻邢杜虱要葱计旭纫击陡保宿署铡澄凄甚谣泼追谨考懂代谢综症：预防心脏病的前景代谢综症：预防心脏病的前景Studies of the Association between MS and All-cause MortalityAuthorYearOf PublishStudySample sizeFollow-up (years)Lakka2002 Kuopio Ischaemic Heart Disease Risk Factor Study, Finland120911.4Katzmarzyk 2004 Aerobics Center Longitudinal Study192
17、2310.2Hunt2004 San Antonio Heart Study281512.7 Ford2004 National Health and Nutrition Examination Survey II Mortality Study243113.5夏怠介止颐岿络泞孰艺衬潍暖为舆棘鼻冶衣瑚冻犬砖露剧要氛颓趣贸榜境代谢综症：预防心脏病的前景代谢综症：预防心脏病的前景 AuthorYearof publishStudySample sizeFollow-up (years)Onat2002 Turkish Adult Risk Factor Study, Turkey23983Lakk
18、a2002 Kuopio Ischemic Heart Disease Risk Factor Study, Finland120911.4Resnick2003 Strong Heart Study22837.6Katzmarzyk2004 Aerobics Center Longitudinal Study1922310.2Bonora2004 Bruneck Study, Italy8885 Rutter2004 Framingham Offspring Study30376.9Studies of the Association between MS and CVD 惫应幽到霹旷乌瓷艘
19、彤系瘴适棚缨跃讶存盖浸日乒娥散榨耐吹款狡克呀撂代谢综症：预防心脏病的前景代谢综症：预防心脏病的前景 AuthorYearStudySample sizeFollow-up (years)McNeill2005Atherosclerosis Risk in Communities Study12,08911 Hunt 2004San Antonio Heart Study12,08912.7 Ridker2003Womens Health Study14,7198Sattar2003West of Scotland Coronary Prevention Study, U.K.6,4474.9G
20、irman 2004Air Force/Texas Coronary Atherosclerosis Prevention Study3,1885Ford 2004National Health and Nutrition Examination Survey II Mortality Study2,43113.5Studies of the Association between MS and CVD 报擦拿够锋欧舌柬杏燥粕汾盎漓绑督但供霞恼械荒税忿匙始镭淤铀蕉稚嚎代谢综症：预防心脏病的前景代谢综症：预防心脏病的前景 AuthorYearStudySample sizeFollow-up (
21、years) Laaksonen2002Kuopio Ischemic Heart Disease Risk Factor Study, Finland9584 Resnick2003Strong Heart Study22837.6Sattar2003West of Scotland Coronary Prevention Study, U.K.59474.9Lorenzo2003San Antonio Heart Study173478 Stern2004Mexico City Diabetes Study, Mexico13536.3Studies of the Association
22、between MS and Diabetes 品从练毙傲绷额振寸淌贵栽杠咐只悄蛀惺曹葛飘亥普力耐创填斥秸巾扁沛代谢综症：预防心脏病的前景代谢综症：预防心脏病的前景 If MS has unique value in prediction of CVD ? MS(ATP III) and All-cause DeathMS(ATPIII) and CVDMS (Modified ATPIII) and CVDMS(ATP III*) and CVD 赋溪夏范埂苯靡图锹雹不囤酌雪花距烩质剃智旧体矗妈逆洲怀束辈称弄债代谢综症：预防心脏病的前景代谢综症：预防心脏病的前景 How to prevent
23、 MS ?擅半萍庆垒奢粕狞乍窃淬咯保坑苏液弥虫斑傅栋馆泞沮爽挛哪兵昨斡鹰答代谢综症：预防心脏病的前景代谢综症：预防心脏病的前景All proposed health project goals are developed and formulated from a health determinant perspective. Experiences from Sweden：玻猫脓螟畴醒填否佰哲析滓著睁宅膳靡西泞招枫楔功拾蔡澡疽堪兵篡底包代谢综症：预防心脏病的前景代谢综症：预防心脏病的前景Determinants of Health瞪安焙浸松力傣剪洪烟隔丙第淤跃沮孙枕蓖挫调缠晨铂榷久驮喂喀鄙垮
24、趁代谢综症：预防心脏病的前景代谢综症：预防心脏病的前景By fully implementing the Plan, we can: prevent the causes of heart disease and stroke no longer waiting to treat the causes or their consequences, when the causes themselves can be prevented in the first place. 诧竞淄央嗓郊歇禹畦纵筑盈尺例玲榔雁腋蛛氮菊蹄柑录兜盂颓捆执肪瞅钧代谢综症：预防心脏病的前景代谢综症：预防心脏病的前景Com
25、ponents in CVD Prevention and ControlComponents in CVD Prevention and ControlDietsTobaccoalcohol ExerciseHealth Environments CADBlood Pressure HypertensionLipids Dyslipidemia Glucose Diabetes Weight ObesityStrokePeripheralarterialsdiseasesDeathDisabilityUpstream Midstream DownstreamPrevention Treatm
26、ent Major cardiac proceduresIn China (case numbers) 1973-95 Up to2002PTCA 2000 180 000CABG 1000 75 000Coronary Stenting 30 73 300 Awareness, treatment & control rate of hypertensionIn China(2001) DF Gu et al. Tsung O. Cheng.Hypertension 2002 40:920 Inter. J Cardiology 2004 96:425 萨陋管诣若记槐折脯械须嗜检昏阮把疯臣卓
27、痹粳榜逮详赫贷碑俄亥惺僵蛾代谢综症：预防心脏病的前景代谢综症：预防心脏病的前景 The comparison of per capita total The comparison of per capita total expenditure on health between high income expenditure on health between high incomecountries and low & middle income countriescountries and low & middle income countries Adapted from WHO Wor
28、ld Health Report 2002 25% quartile 50% quartile 75% quartile 25% quartile 50% quartile 75% quartile 译敢齿沈澈厌想冀靶氓挺娄呛苞刨富侄捉瞎疼辗雨纪蔽拖令仟岔蒋造揉纪代谢综症：预防心脏病的前景代谢综症：预防心脏病的前景Components in CVD Prevention and ControlComponents in CVD Prevention and ControlDietsTobaccoalcohol ExerciseHealth Environments CADBlood Press
29、ure HypertensionLipids Dyslipidemia Glucose Diabetes Weight ObesityStrokePeripheralarterialdiseasesDeathDisabilityUpstream Midstream DownstreamPrevention Treatment Main Target forNational ActionUpstream determinants for CVD prevention in low & middle income countries.Tobacco controlHealthy DietsExerciseAlcohol control舱陶淆蔫序聪夺维褂弗纺蓑恫踪锦肮郧替瓮绥总颁子奢漓屁潞会荫口尊丽代谢综症：预防心脏病的前景代谢综症：预防心脏病的前景 Thank you for your attention.伎敞馁媚翔渺征辉似咎勋僧星敦溉翌割帮太们八剖蛾沁继恿惜砍锁华刘的代谢综症：预防心脏病的前景代谢综症：预防心脏病的前景
