Metabolic Syndrome & Macrovascular Complications PDF

12.5 metabolic syndrome and macrovascular complications A. Metabolic Syndrome 1. Introduction & Background Definition: Metabolic Syndrome (MeS) is a cluster of cardiovascular disease risk factors linked to insulin resistance.  between d...

12.5 metabolic syndrome and macrovascular complications A. Metabolic Syndrome 1. Introduction & Background Definition: Metabolic Syndrome (MeS) is a cluster of cardiovascular disease risk factors linked to insulin resistance.  between diabetes, gout, and hypertension. 1990s: Recognition of visceral obesity as a key component of insulin resistance syndrome (also known as Syndrome X or the Deadly Quartet). 2. Definitions -ATP III (2005): Diagnosis requires any 3 of the following 5 criteria: a. Obesity: Waist circumference Men: ≥ 102 cm Women: ≥ 88 cm b. Glucose: Fasting glucose ≥ 5.6 mmol/L or known diabetes. c. Lipids: Triglycerides: ≥ 1.7 mmol/L HDL: Men ≤ 1 mmol/L; Women ≤ 1.3 mmol/L. d. Blood Pressure: ≥ 130/85 mm Hg or known hypertension. IDF (2006): Requires visceral obesity + 2 or more criteria from above. 3. Associated Conditions Polycystic ovarian disease Fatty liver disease Chronic kidney disease Obstructive sleep apnoea Hyperuricemia/gout Low-grade inflammation and endothelial dysfunction 4. Pathophysiology of Metabolic Syndrome Visceral Obesity: Central to the development of MeS; fat cells secrete hormones that disrupt insulin action. Insulin Resistance: Impairs glucose uptake and promotes lipolysis, leading to increased free fatty acids (FFAs). Neurohormonal Activation: Adipose tissue secretes hormones like Angiotensin II, contributing to hypertension. Chronic Inflammation: Adipocytokines (e.g., TNFα, IL-6) lead to endothelial dysfunction and vascular disease. Dysglycemia: Impaired glucose homeostasis; pre-diabetes is a significant risk factor for Type 2 diabetes. Dyslipidaemia: Characterized by high triglycerides and VLDL, low HDL, and small dense LDL particles. Hypertension: Resulting from insulin resistance and activation of the Renin-Angiotensin System (RAS). Endothelial Dysfunction: Increases risk of atherosclerosis and thrombotic events. 6. Management of Metabolic Syndrome Recognition: Identify patients with visceral obesity and associated metabolic abnormalities. -Lifestyle Interventions: Diet and weight reduction. Regular exercise Smoking cessation -Pharmacological Therapy: Treat each risk factor if lifestyle changes are insufficient (e.g., glucose abnormalities, hypertension, dyslipidaemia). B. Macrovascular Complications Macrovascular disease risk factors in diabetic patients · hypertension · dyslipidaemia · diabetic kidney disease · insulin resistance · obesity 1. Types of Macrovascular Disease Cerebrovascular Disease: Ischemic events (thrombosis, embolism) and haemorrhagic strokes. Transient Ischemic Attacks (TIAs). Ischemic Heart Disease: Angina Pectoris and Acute Coronary Syndrome. Symptoms include central crushing chest pain and autonomic symptoms. -Peripheral Vascular Disease:  Atherosclerosis affecting peripheral vessels leading to reduced blood and oxygen supply. Symptoms include intermittent claudication, rest pain, and potential gangrene. ![ 2. Key Takeaways 1. Visceral Obesity: Major risk factor for metabolic abnormalities. 2. Dysglycemia: Important criterion for diagnosing MeS; does not require overt diabetes. 3. Independent Risk Factors: Components of MeS (dysglycemia, hypertension, dyslipidaemia) are independent risk factors for macrovascular disease. 4. Holistic Patient Care: In managing Type 2 Diabetes, consider all aspects beyond glucose control. 5. Prevention Focus: Treatment aims to prevent macrovascular disease and its serious consequences.