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Update on the Metabolic SyndromeSteven Haffner, MD Metabolic Syndrome Increases Risk for CHD and Type 2 Diabetes High Risk of Impaired Glucose Tolerance and Type 2 Diabetes by OGTT in Post-MI Patients without Known Diabetes Increased Metabolic Syndrome in Prediabetic Subjects: Baseline Risk Factors in Subjects with Normal Glucose Tolerance at Baseline according to Conversion Status at 8-Year Follow-up: San Antonio Heart Study Elevated Risk of CVD Prior to Clinical Diagnosis of Type 2 Diabetes: Nurses’ Health Study Risk of Major CHD Event Associated with Insulin Quintiles in Nondiabetic Subjects: Helsinki Policemen Study CVD Risk Factors across HOMA-IR Quintiles: San Antonio Heart Study (Phase II) Definitions of the Metabolic Syndrome According to clinical outcomes According to underlying causes According to metabolic components According to clinical criteria Definition of Metabolic Syndrome:According to Underlying Causes Insulin resistance (1999 WHO) Insulin resistance syndrome Lifestyle: especially obesity (NCEP ATP III) Metabolic syndrome Subclinical inflammation Therapeutic Implications: According to Underlying Causes Insulin resistance Treat insulin resistance Lifestyle: especially obesity Prevent and treat obesity Subclinical inflammation Treat obesity Statins, TZDs, etc. ATP III: The Metabolic SyndromeDiagnosis is established when ?3 of these risk factors are present Prevalence of the NCEP Metabolic Syndrome: NHANES III by Age Prevalence of the NCEP Metabolic Syndrome: NHANES III by Sex and Race/Ethnicity Prevalence of CHD by the Metabolic Syndrome and Diabetes in the NHANES Population Age 50+ ATP III Metabolic Syndrome:Therapeutic Implications Focus on obesity (especially abdominal obesity) as the underlying cause of the metabolic syndrome Therefore, prevent development of obesity in the general population Also, treat obesity in the clinical setting (NHLBI/NIDDK Obesity Education Initiative) Different Components of the NCEP Metabolic Syndrome Pred