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【正文】 l Abdominal obesity (Waist circumference) Men Women 102 cm (40 in) 88 cm (35 in) TG ?150 mg/dl HDLC Men Women 40 mg/dl 50 mg/dl Blood pressure ?130/?85 mm Hg Fasting glucose ?110 mg/dl ATP III: The Metabolic Syndrome Diagnosis is established when ?3 of these risk factors are present Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. JAMA 2021。287:356359. Prevalence, % 20–70+ Age, years 20–29 30–39 50–59 60–69 ?70 Men Women 24% 23% 8% 6% 44% 44% 0%10%20%30%40%50%0%10%20%30%40%Prevalence of the NCEP Metabolic Syndrome: NHANES III by Sex and Race/Ethnicity Prevalence, % Men Ford ES et al. JAMA 2021。52:12101214.. ATP III Metabolic Syndrome: Therapeutic Implications ? Focus on obesity (especially abdominal obesity) as the underlying cause of the metabolic syndrome ? Therefore, prevent development of obesity in the general population ? Also, treat obesity in the clinical setting (NHLBI/NIDDK Obesity Education Initiative) Variable Odds Ratio Lower 95% Limit Upper 95% Limit Waist circumference Triglycerides HDL cholesterol* Blood pressure* Impaired fasting glucose Diabetes* Metabolic syndrome Different Components of the NCEP Metabolic Syndrome Predict CHD: NHANES *Significant predictors of prevalent CHD Prediction of CHD Prevalence using Multivariate Logistic Regression Copyright 169。 12101214 Reprinted with permission from The American Diabetes Association. 0% 2% 4% 6% 8% 10%BMI per kg/m2 HDLC per mg/dl decrease SBP per mm Hg FPG per mg/dl Different Components of the NCEP Metabolic Syndrome Predict Diabetes: San Antonio Heart Study Stern MP et al. Ann Intern Med 2021。 40 mg/dl (women) ? BMI 30 and/or W/H (men), (women) ? Urinary albumin 20 mg/min。285:24862497. WHO Metabolic Syndrome Definition 1999: Therapeutic Implications ? Focus on insulin resistance as the underlying cause of the metabolic syndrome ? More emphasis on the geic basis of the metabolic syndrome rather than obesity ? Leads to increased thinking about the use of drugs to treat insulin resistance in patients with the metabolic syndrome Therapeutic Implications of Definition of Metabolic Syndrome ? If focus is on obesity as underlying cause ? Prevent and treat obesity ? If focus is on insulin resistance as underlying cause ? Treat insulin resistance ? If focus is on metabolic risk factors ? Treat individual risk factors Criteria for Comparing Different Definitions of Metabolic Syndrome ? Risk of: ? CHD ? DM ? Relation to: ? Insulin resistance ? Obesity ? Prevalence in munity could differ by race ? How simple is the definition? Intensity of Therapy Should be Proportionate to Level of Risk ? What is the impact of the metabolic syndrome on health outes? ?Cardiovascular disease ?Type 2 diabetes Cardiovascular Disease Mortality Increased in the Metabolic Syndrome: Kuopio Ischaemic Heart Disease Risk Factor Study Lakka HM et
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