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【正文】 Update on the Metabolic Syndrome Steven Haffner, MD ： ； :； ： Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. JAMA 2021。285:24862497. Metabolic Syndrome Increases Risk for CHD and Type 2 Diabetes Coronary Heart Disease Type 2 Diabetes High LDLC Metabolic Syndrome ： ； :； ： At discharge 3 mo later At discharge High Risk of Impaired Glucose Tolerance and Type 2 Diabetes by OGTT in PostMI Patients without Known Diabetes IGT % of Patients 3 mo later New DM 35% 40% 31% 25% n = 181 Norhammar A et al. Lancet 2021。359:21402144. 020406080100Conversion Status at Followup Diabetes (n=18) Normal (n=490) P BMI (kg/m2) ? ? .472 Centrality* ? ? .472 TG (mmol) ? ? .006 HDLC (mmol) ? ? .045 SBP (mm Hg) ? ? .004 Fasting glucose (mmol) ? ? .032 Fasting insulin (pmol) 157 ? 27 81 ? 5 .006 Increased Metabolic Syndrome in Prediabetic Subjects: Baseline Risk Factors in Subjects with Normal Glucose Tolerance at Baseline according to Conversion Status at 8Year Followup: San Antonio Heart Study Haffner SM et al. JAMA 1990。263:28932898. * Ratio of subscapular to triceps skinfolds Nondiabetic throughout the study Prior to diagnosis of diabetes Elevated Risk of CVD Prior to Clinical Diagnosis of Type 2 Diabetes: Nurses’ Health Study Copyright 169。 2021 American Diabetes Association From Diabetes Care, Vol. 25, 2021。 11291134 Reprinted with permission from The American Diabetes Association. Relative Risk 1 After diagnosis of diabetes Diabetic at baseline 0123456Risk of Major CHD Event Associated with Insulin Quintiles in Nondiabetic Subjects: Helsinki Policemen Study 0 . 7 00 . 7 50 . 8 00 . 8 50 . 9 00 . 9 51 . 0 0Years 5 10 20 0 15 25 Py246。r228。l228。 M et al. Circulation 1998。98:398404. Log rank: Overall P = .001 Q5 vs. Q1 P .001 Q1 Q2 Q3 Q4 Q5 Proportion without Major CHD Event 0 HOMAIR Q1 Q2 Q3 Q4 Q5 HDLC (mg/dl) LDLC (mg/dl) Cholesterol (mg/dl) Triglyceride (mg/dl) Systolic BP (mm Hg) Diastolic BP (mm Hg) CVD Risk Factors across HOMAIR Quintiles: San Antonio Heart Study (Phase II) All p(trend) 。 quintile cutpoints: , , , Adjusted for age, sex, ethnicity Copyright 169。 2021 American Diabetes Association From Diabetes Care, Vol. 25, 2021。 11771184 Reprinted with permission from The American Diabetes Association. Definitions of the Metabolic Syndrome ? According to clinical outes ? According to underlying causes ? According to metabolic ponents ? According to clinical criteria Definition of Metabolic Syndrome: According to Underlying Causes ? Insulin resistance (1999 WHO) ?Insulin resistance syndrome ? Lifestyle: especially obesity (NCEP ATP III) ?Metabolic syndrome ? Subclinical inflammation WHO. Definition, Diagnosis and Classification of Diab
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