代谢综合征和冠心病

ATP III: >3 of following
• WC >102 cm (men),
>88 cm (women)
• TG > 1.7 mmol/L • HDL < 1.04 mmol/L
(men), < 1.30 mmol/L (women)
• BP >130/ > 85 mmHg • G > 6.1 mmol/L
每千人冠心病发病率
200
150
100
50
女性
0
男性
<25 25–34 35–44 45–54 55–64 65–74 75+
HDL-C (mg/dl)
Gordon, Castelli et al. Am J Med 1977; 62: 707–714
在高、中、低HDL-C水平人群中冠心病事件发生率 —4个北美研究的结果
血压与冠心病死亡率
IHD Mortality (Floating absolute risk and 95% CI)
Systolic Blood Pressure
Age at risk
256
80-89 years
128
70-79 years
Diastolic Blood Pressure
Age at risk
CRP 和 LDL-C 水平与心血管疾病相对危险
Relative Risk of CV Disease
3
2.5
2
1.5
1
0.5
0
>160 130-160
LDL-Cholesterol (m g/dl)
<130
>3 1-3 CRP <1
Multivariate-adjusted RR: Women’s Health Study, Ridker NEJM 2002:347:1557
MRFIT Jamerson. Am J Hypertens. 2000;13:68S-73S.
PROCAM:危险因子的组合对MI发病的影响
120 100
80 60 40 20
0
Incidence of MI/1000 pts
Prevalence (%):
54.9
22.9
2.6
2.3
9.4
8.0
Assman G, Schulte H. Am Heart J 1988;116:1713–1724
• 与致动脉粥样硬化的小密 度脂蛋白增加相关
Relative Risk
BMI p<0.001 WHR p<0.001
3 2.5
2 1.5
1 0.5
0 12345
Quantiles
Hubert et al. Circulation 1983; Cho et al. Eckel et al. Circulation 1997;Diabetes Care 2002; Folsom et al. JAMA 1993
256
80-89 years
128
70-79 years
64
60-69 years 64
60-69 years
32
50-59 years 32
50-59 years
16
40-49 years 16
40-49 years
8
8
4
4
2
2
1
1
0
0
120 140 160 180
70 80 90 100 110
Usual Systolic BP (mm Hg)
Usual Diastolic BP (mm Hg)
IHD=ischemic heart disease.
Prospective Studies Collaboration. Lancet. 2002;360:1903-1913.
HDL-C与冠心病 Framingham Heart Study
CHD events per 1000 per year
18
16
14 12
10
8 6
4
2 0
<40
40-49
>=50
Plasma HDL-C(mg/dl)
FHS men CPPT placebo FHS women MRFIT LRCF men LRCF women
45% P<0.001
20%
No Prior MI*
MI
MI=myocardial infarction.
*These patients had no prior MI at baseline.
Haffner et al. N Engl J Med. 1998;339:229-234.
8
危险因素增加对糖尿病和非糖尿病患者心血管 死亡率的影响
7-Year Incidence Rate of MI
2型糖尿病和冠心病: 致死/非致死MI7-年发生 率) (East West Study)
Nondiabetic
50
n=1373
45
40 P<0.001
35
30
25
20
19%
15
10
5
4%
0
No Prior MI*
MI
Diabetic n=1059
(>0.9 men, >0.85 women)
• TG > 1.7 mmol/L +/or HDL
<0.9 (men), <1.0 (women)
• BP >160/90 mmHg or meds • Microalbuminuria (urinary
AER >20 ug/min,or A/Cr >30mg/g)
代谢综合征和冠心病
党爱民 中国医学科学院 阜外心血管病医院
2006/6/3
提纲
• MS定义特征 • MS危险因素组分与CHD的关系 • MS危险因素组分致CHD 机制 • MS及危险因素的综合干预
代谢综合征的定义
WHO:
• DM or IFG/IGT and > 2 of
following
• BMI > 30 kg/m2 +/or WHR
内脏肥胖与冠心病危险
ቤተ መጻሕፍቲ ባይዱ
• Framingham研究,肥胖与 心血管疾病相关联
• Nurses’ Health Study,肥 胖与 冠心病危险性增加相 关联
• 腹部内脏脂肪较BMI与总 死亡率具更强的相关性
• 增加其他危险因素的发生 率(DM,HNT,dislipidemia, prothrombotic state)
Age-Adjusted CV Death Rate per 10,000 Person-years
140
120
Nondiabetic
100
Diabetic
80
60
40
20
0
0
1
2
3
Number of Risk Factors*
*Increased systolic BP, elevated total cholesterol, smoking.