IRS: AACE Criteria
Diagnosing Insulin Resistance Syndrome Is as Simple as 1 plus 2
Choose:
One Risk + Two Parameters
IRS: AACE Criteria – Risks (Choose 1)
Reaven G. Diabetes. 1988;37:1565-1607.
The Metabolic Syndrome: Current Perspective
Body Size BMI Central Adiposity
Insulin Resistance
+
Hyperinsulinemia
Obesity and Metabolic Syndrome
Steven M. Haffner, MD
Conceptual Framework for the Metabolic Syndrome

Environmental causes are responsible for the epidemic of the metabolic syndrome (NCEP)

Personal Dx of HTN, TGL, low HDL or CVD
Acanthosis nigricans



Polycystic ovarian syndrome (PCOS)
Nonalcoholic fatty liver disease (NAFLD) Cancer (obesity related)
n = 2,815 (age 25-64) – Both NCEP and WHO metabolic syndrome, 509 – NCEP alone, n=197 – WHO alone, n=199 12.7 year follow-up (229 deaths) Three populations considered – Overall population – No CVD at baseline – No CVD or diabetes at baseline (primary prevention)
–
Treatment:
reduce obesity and increase activity

Insulin resistance is the underlying cause of the metabolic syndrome (WHO)
–
Treatment:
a) reduce obesity and increase activity b) insulin sensitizers
WHO Metabolic Syndrome Definition 1999: Based on Clinical Criteria


Insulin resistance (type 2 diabetes, IFG, IGT)*
Plus any 2 of the following:
– – – – –
36%
40% 30% 20% 10% 0%
African American
28%
25% 21% 16%
26% 23% 20%
Men
Ford ES et al. JAMA 2002;287:356-359.
Women
Botnia Study
Prevalence of CHD in Patients with the Metabolic Syndrome
Metabolic Syndrome Increases Risk for CHD and Type 2 Diabetes
High LDL-C
Metabolic Syndrome Type 2 Diabetes
Coronary Heart Disease
Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. JAMA 2001;285:2486-2497.
Defining Level
>102 cm (>40 in) >88 cm (>35 in) >150 mg/dL <40 mg/dL <50 mg/dL >130/>85 mm Hg >110 (>100)**mg/dL
** 2003 New ADA IFG criteria (Expert Panel…,Diabetes Care 26:3160-3167, 2003)
* The Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. JAMA. 2001;285:2486-2497. **The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus: Follow-up report on the diagnosis of diabetes mellitus. Diabetes Care 26:3160-3167, 2003
15
Cumulative Hazard, %
Cardiovascular Disease Mortality RR (95% CI), 3.55 (1.98–6.43)
10
Metabolic Syndrome:
YES
5
NO
0
0
2
4 6 8 Follow-up, year
10
12
Lakka HM et al. JAMA 2002;288:2709-2716.

Prevalence of the NCEP Metabolic Syndrome: NHANES III by Age
50% 40%
Men Women
24% 23%
44% 44%
Prevalence, %
30% 20% 10% 0%பைடு நூலகம்
8% 6%
20–70+ 20–29
30–39
40–49
50–59
The Metabolic Syndrome: Historical Perspective
1988: Syndrome X
Insulin Resistance
Glucose Intolerance
Hyperinsulinemia
TG
HDL-C
Hypertension
CORONARY HEART DISEASE
*Diagnosis is established when >3 of these risk factors are present
Risk Factor
Abdominal obesity† (Waist circumference‡) Men Women TG HDL-C Men Women Blood Pressure Fasting glucose
SNS activity Na retention Hypertension
CRP PAI-1 Fibrinogen
CORONARY HEART DISEASE
Adapted from Reaven G. Drugs. 1999;58 (suppl):19-20
ATP III: The Metabolic Syndrome*


IRS: AACE Criteria – Parameters (Choose 2)

Triglycerides >150 mg/dl

HDL cholesterol – Men <40 mg/dl – Women <50 mg/dl
Blood pressure >135/85 Blood glucose – 2-hour >140 mg/dl, OR – Fasting 110 – 125 mg/dl
No MS/No DM 54.2%
MS/No DM 28.7%
DM/No MS 2.3%
DM/MS 14.8%
Alexander CM et al. Diabetes 2003;52:1210-1214..
NCEP vs WHO Metabolic Syndrome in Relationship to CVD Mortality: San Antonio Heart Study
Elevated BP (>140/90 or drug Rx) Plasma TG >150 mg/dl HDL <35 mg/dl (men); <40 mg/dl (women) BMI >30 and/or W/H >0.9 (men), >0.85 (women) Urinary albumin >20 mg/min; Alb/Cr >30 mg/g
Glucose Metabolism
±
Uric Acid Metabolism

Dyslipidemia

Hemodynamic

Novel Risk Factors

Glucose intolerance
Uric acid Urinary uric acid clearance
TG PP lipemia HDL-C PHLA Small, dense LDL