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Metabolic Syndrome
Clustering of abdominal obesity, dyslipidemia
hypertension, and insulin resistence.
Defined as any 3 of the following risk factors
(ATP III, 2001
Dislipidemia
TC 210 mg/dL
X1.3
X4.5
X2.3
Toleransi glukosa
X1.8
Hipertensi
SBP 195 mmHg
X3
X5.2
X5.3
X8.7
Dislipidemia
TC 235 mg/dL
X1.7
X2.9
Merokok
X1.7
Perubahan hemodinamik :
- Symphotettic nervous system activity
- Renal sodium retention
- Blood pressure(~50% of patient with
hypertention are insulin resistent )
Ganguan hemostatis
- Plasminigen activator inhibitor I
- Fibrinogen
Disfungsi Endotel :
- Mononuclear cell adhesion
- Plasma concentration of celular
nadhesion molecules
- Plasma concentration of acymmetric
dimethyl arginine
- Endothelial-dependent vosodilation
Sistim reproduksi
- Polycystic ovary syndrome
Early Life
Adult Life
Metabolik Syndrome
Cardiovascular disease
GENES
Diabesity
(Metabolic Syndrome)
Hipertension
Hyperglykemia
Obesity
Dyslipidemia
Metabolik
syndrome
Intervention/
Control
Atherosclerosis
Cardiovascular
disease
Treatment of obesity
Multiple risk reducer
Microalbuminuria
INSULIN RESISTENCE
Decraesed fibrinolitic
Octivity ( PAI-1 )
Endothelial dysfunction
Inflammatory markers
Of a the rosclerosis
Mikroalbuminuria
Normal
TGT
Diabetes
Tipe 2 komplikasi
kematian
Tahap
Preklinik
Klinik
Komplikasi
Pencegahan
primer
Pencegahan
Skunder
Pencegahan
Tertier
Secondary
prevention
Coronary
Thrombosis
Events
Stroke
Myocardial
Ischemia
CAD
Atherosclerosis
Primary
prevention
Risk Factors
( Dyslipidemia,
Dyslipidemia BP, DM,
Insulin Resistance, Platelets,
Fibrinogen, etc)
Arrhythmia and
Loss of Muscle
Remodeling
Ventricular
Dilatation
Congestive
Heart Failure
End-stage
Heart Disease
Adapted from
Dzau et al. Am Heart J. 1991;121:1244-1263
Why primary
prevention ?
CAD
Atherosclerosis
Primary
prevention
Risk Factors
( Dyslipidemia, BP, DM,
Insulin Resistance, Platelets,
Fibrinogen, etc)
Adapted from
Dzau et al. Am Heart J. 1991;121:1244-1263
Primary Prevention
Cost-effective
Less
painful
Better quality of life
Easier to manage
But..
Klasifikasi:
Pemeriksaan
DISLIPIDEMIA
1.
2.
3.
4.
LDL-C
0-1
>130 mg/dl
Monocyte
LDL-C
Adhesion
molecule
Macrophage
Oxidized
LDL-C
Foam cell
CRP
Smooth muscle
cells
Endothelial
dysfunction
Inflammation
Oxidation
Plaque instability
and thrombus
Tuzcu EM, Kapadia SR, Tutar E, et al. High Prevalence of Coronary Atherosclerosis in Asymptomatic Teenagers And Young Adults: EvidenceFrom
Intravascular Ultrasound. Circulation 2001;103:2705-2710
Pulmonary embolism
(PE)
Deep vein
thrombosis (DVT)
Pulmonary embolism
(PE)
Deep vein
thrombosis (DVT)
From a prospective analysis of 1886 patients aged 62 years, 810 patients were diagnosed with CAD as defined by a
documented clinical history of MI, ECG evidence of Q-wave MI, or typical angina without previous MI. (Adapted
from Aronow et al.)
Murabito JM, Evans JC, Larson MG, et al. Prognosis After the Onset of Coronary Heart Disease. An Investigation of Differences In
Outcome Between the Sexes According To Initial Coronary Disease Presentation. Circulation 1993;88:2548-2555
CVD deaths
CHD deaths
1000
500
0
Russia Poland Finland New England/ USA
Zealand Wales
Italy
Spain
Japan
Cardiovascular mortality
(10,000 person-years)
Diabetics
100
80
60
40
Non-diabetics
20
0
0
hypercholesterolaemia, smoking,
hypertension
Adapted from: Stamler, J. et al., Diabetes Care 1993; 16: 434-44
Risk factor
LDL-C
0-1
< 160
mg/dl
< 130
mg/dl
< 100
mg/dl
70 mg/dl
LDL
>190 mg/dL
Mulai statin
Periksa ulang 3bln
Sasaran:
LDL < 160 mg/dL
LDL
130 159 mg/dL
LDL
>160 mg/dL
Mulai statin
Periksa ulang 3bln
Sasaran:
LDL < 130 mg/dL
Pencegahan Primer
Pada Pasien dengan > 2 Faktor Risiko
Mulai dengan obat
hipolipidemik
6 minggu
Pemantauan respons
dan ketaatan berobat
Sasaran:
LDL < 100 mg/dL
NCEP-ATP III Report. JAMA 2001;285:2486-2497
RSV 10 mg (n=165)
RSV 20 mg
ATV 10 mg (n=157)
ATV 20 mg
Placebo (n=79)
RSV 20 mg
Metabolic syndrome
CHD risk >10%
Statin nave
18 years
Visit:
1
Week: 4
2
2
3
0
4
6
5
12
Lipids
hsCRP
Safety
Lipids
hsCRP
Safety
Lipids
hsCRP
Safety
LSM change
from baseline (%)
20
9.5
10
0
10
**
5.1***
1.1
0.7
***
0.3
***
20
19
30
40
2.8
***
0.9
***
21
28
32 ***
35
***
41
37
***
43
50
LDL-C
HDL-C
TC
TG
nonHDL-C
COMETS Achievement of
100
91
83
80
***
79
*
72
60
40
20
0
***
10
n=164
n=155
n=78
RSV
10 mg
ATV
10 mg
Placebo
6 weeks
n=242
n=155
RSV
ATV
combined 10/20 mg
12 weeks
ITT population by as allocated treatment; *P<0.05, ***P<0.001 vs RSV at same time point
Potential Benefits of
Moderate (5-10%) Weight Loss
Subkutaneus Adipose Tissue
5-10%
Weight loss
Visceral
Adipose Tissue
Blood Preasure
Deteriorated lipid profile improved
Impaired
Insulin sensitivity
Improved
Insulinaemia alycaemia
Susceptibility to thrombosis
Imflamation Markers
Abdominally
Obese (Hight Waist
Measurement)
Reduced Obesity
(Low Waist measure ment)
Obat Hipolipidemik
KESIMPULAN