Cardiometabolic Syndrome in Elderly Women

Rachel McLaughlin PharmD candidate University of Georgia November 6, 2012

Metabolic Syndrome

 ATP III defined a multiplex risk factor for cardiovascular disease (CVD)       Abdominal obesity (increased waist circumference) Dyslipidemia (raised TGs and low HDL) Elevated blood pressure Insulin resistance +/- glucose intolerance Proinflammatory state (elevated CRP) Prothrombotic state (elevated plasma plasminogen activator inhbitor and prothrombin)

Metabolic Syndrome

 Underlying CVD risk factors  Obesity, physical inactivity, atherogenic diet  Major risk factors  Cigarette smoking, hypertension, high LDL, low HDL, family history of premature CHD, aging  Emerging risk factors  High TGs, small LDL particles, insulin resistance, glucose intolerance, proinflammatory state, prothrombotic state

Metabolic Syndrome

 At least three of the following:

Metabolic Syndrome

Metabolic Syndrome

 Increase in risk of CVD outcomes with increasing number of traits  CVD is the primary clinical outcome, but MetS also increases risk for type 2 diabetes and susceptible to polycystic ovary disease, fatty liver, cholesterol gallstones, asthma, sleep disturbances and some cancers

Age- and sex-specific prevalence and ten-year risk for cardiovascular disease of all 16 risk factor combinations of the metabolic syndrome A cross-sectional study Cardiovascular Diabetology, August 2010

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Methods

German Metabolic and Cardiovascular Risk Project (GEMCAS) data from 2005   35,869 participants Ages 18-99, 61% women  Physicians recorded DM and CVD histories and assessed MetS risk factors according to a standardized assessment  Analyzed all 16 combinations of MetS risk factors association with 10-year risk of fatal and nonfatal MI  Calculated age-standardized prevalence rates to compare CV comorbidities prevalence with different combinations

Results

Results

 Most frequent combination in both men and women: WC-BP-GL  More frequent in women than men: WC-HDL-BP  10% vs 3%  In women, the 8 combinations with highest prevalence all included BP and 5 out of 8 included WC

Results

 PROCAM analysis of 10-year risk for MI    Much higher in men than women Women without MetS: 1.2% ; with: 2.3% Highest risk combos for women: TG-HDL-BP-GL, WC-TG-HDL-BP, and all five traits combined  ESC score: 10-year risk of fatal MI   Women without MetS: 1.2% ; with: 1.8% Highest risk combos for women: TG-HDL-BP-GL, WC-TG-HDL-BP

Discussion

 There was a substantial influence of age and gender on the prevalence of combinations   Every GL combo more prevalent in elderly Higher rates of WC in women  Each combination of MetS may not uniformly increase CV risk   HDL and BP frequent in high risk groups Treat these as higher risk factors than the others??

Body composition and its association with cardiometabolic risk factors in the elderly: A focus on sarcopenic obesity

Archives of Gerontology and Geriatrics: September 2012

Methods

 2943 Korean subjects 60 years or older  Body composition categorized into four groups: sarcopenic obese, sarcopenic nonobese, nonsarcopenic obese, and nonsarcopenic nonobese   Sarcopenia = appendicular skeletal muscle mass divided by weight <1 SD below the mean for young adults Obesity = BMI >25 kg/m2  Measured cardiometabolic risk factors  BP, glucose intolerance, lipid profiles, inflammatory markers, vitamin D level

Results

 Sarcopenic obese group had most insulin resistance, metabolic syndrome, and CVD risk factors  Lowest HDL and vitamin D levels in the sarcopenic obese group  BP, glucose, lipid profiles -risk factors for CVD significantly associated with the obese subjects

Discussion

 Skeletal muscle is a primary tissue responsible for insulin-mediated glucose disposal so muscle loss causes diminished glucose disposal  High fat mass secretes proinflammatory adipocytokines  We need to focus on both obesity and muscle loss

What do we do?

 Obesity    ATP III recommends tackling this first: lowers cholesterol, raises HDL, lowers blood pressure and glucose Lose 10% of body weight Reinforce with physical activity... help with sarcopenia  Insulin resistance  Blood pressure  Lipids  Several drugs will also lower CRP levels

 For women, especially look at waist circumference, low HDL, high triglycerides and blood pressure as these caused the highest CV risk in elderly women  As people age, look carefully for signs of insulin resistance and treat appropriately  Exercise!

References

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Chung, Ji-Youn, Hee-Taik Kang, Duk-Chul Lee, Hye-Ree Lee, Yong-Jae Lee. Body composition and its association with cardiometabolic risk factors in the elderly: A focus on sarcopenic obesity. Archives of Gerontology and Geriatrics. September 2012.

Grundy, Scott, Brewer, Jr,H. Bryan, Cleeman, James, Smith, Jr, Sidney, and Lenfant, Claude. Definition of Metabolic Syndrome: Report of the National Heart, Lung, and Blood Institute/ American Heart Association Conference on Scientific Issues Related to Definition. Circulation. 2004; 109:433-438.

Moebus, Susanne, Balijepalli, Chakrapani, Lösch Christian, Laura Göres, Bernd von Stritzky, Bramlage, Peter, Jürgen Wasem, Karl-Heinz Jöckell. Age- and sex-specific prevalence and ten-year risk for cardiovascular disease of all 16 risk factor combinations of the metabolic syndrome - A cross-sectional study. Cardiovascular Diabetology. 2010: 9:34.