4. Hypertension The other
metabolic sy
C-II terol. This red
C-III HDL cholesterol
B-100 and HDL compo
TG
Small dense LDL FFA Insulin IL-6 SNS ence of hyp
VLDL
cholesterol c
Glucose duced choles
core in comb
TNF-α − protein–med
IL-6 Insulin
ing the parti
−
CRP poprotein co
Glycogen
− clearance of
− tionships of
sistance are
FFA CO2
− with the cha
FFA metabolism.
In additio
− composition
Fibrinogen
Adiponectin mM (~180 m
PAI-1
dominance o
Prothrombotic Triglyceride are thought
state (intramuscular droplet) toxic to the e
FIGURE 236-2 Pathophysiology of the metabolic syndrome. Free fatty acids (FFAs) through the
adhere to gl
5. 1510 TABLE 236-1 NCEP:ATPIII 2001 AND IDF CRITERIA FOR THE METABOLIC SYNDROME Aging The metabol
of the U.S. populati
NCEP:ATPIII 2001 IDF Criteria for Central Adipositya greater percentage of
Three or more of the following: Waist Circumference have the syndrome th
dency of the syndrom
PART 9
Central obesity: Waist circumference >102 cm
(M), >88 cm (F) Men Women Ethnicity most populations aro
Hypertriglyceridemia: Triglycerides ≥150 mg/dL ≥94 cm ≥80 cm Europid, Sub-Saharan
or specific medication African, Eastern & Diabetes Mellitus D
Low HDL cholesterol: <40 mg/dL and <50 mg/ Middle Eastern the NCEP and Intern
dL, respectively, or specific medication ≥90 cm ≥80 cm South Asian, Chinese, tion (IDF) definition
Hypertension: Blood pressure ≥130 mm systolic and ethnic South &
or ≥85 mm diastolic or specific medication drome. It is estimate
Central American
Disorders of the Cardiovascular System
Fasting plasma glucose ≥100 mg/dL or specific ≥85 cm ≥90 cm Japanese
(~75%) of patients
medication or previously diagnosed type 2 impaired glucose to
diabetes Two or more of the following: metabolic syndrome.
Fasting triglycerides >150 mg/dL or specific abolic syndrome in
medication
to a higher prevalen
HDL cholesterol <40 mg/dL and <50 mg/dL for
men and women, respectively, or specific patients with type 2
medication the syndrome.
Blood pressure >130 systolic or >85 mm diastolic
or previous diagnosis or specific medication Coronary Heart Disease
Fasting plasma glucose ≥100 mg/dL or previously alence of the metabo
diagnosed type 2 diabetes
with coronary heart
aInthis analysis, the following thresholds for waist circumference were used: White men, ≥94 cm; African-American with a prevalence of
men, ≥94 cm; Mexican-American men, ≥90 cm; white women, ≥80 cm; African-American women, ≥80 cm; Mexican- mature coronary arte
American women, ≥80 cm. For participants whose designation was “other race—including multiracial,” thresholds ticularly in women.
that were once based on Europid cut points (≥94 cm for men and ≥80 cm for women) and once based on South
rehabilitation and cha
Asian cut points (≥90 cm for men and ≥80 cm for women) were used. For participants who were considered “other
Hispanic,” the IDF thresholds for ethnic South and Central Americans were used.
trition, physical activi
Abbreviations: NCEP:ATPIII, National Cholesterol Education Program, Adult Treatment Panel III; IDF, International Di- in some cases, pha
abetes Foundation HDL, high-density lipoprotein. prevalence of the synd
6. fattori di rischio
• obesità
• sedentarietà
• età
• diabete: ~75% pz con DM II ha sindrome
metabolica
• malattia coronarica
• dislipidemie
7. • resistenza insulina per aumento acidi grassi
circolanti
• insulina normalmente inibisce lipolisi e favolisce
LPL
• aumenta produzione epatica di glucosio e VLDLs
• in condizioni fisiologiche insulina è valodilatatore
8. ortant
criteria Hypertension The relationship between insulin resistance and hyper-
ference tension is well established. Paradoxically, under normal physiologic
ases in conditions, insulin is a vasodilator with secondary effects on sodium
quires reabsorption in the kidney. However, in the setting of insulin resis-
tissue- tance, the vasodilatory effect of insulin is lost, but the renal effect on
ases in sodium reabsorption is preserved. Sodium reabsorption is increased
ystem- in Caucasians with the metabolic syndrome but not in Africans or
olism. Asians. Insulin also increases the activity of the sympathetic nervous
e with system, an effect that may also be preserved in the setting of the insulin
ay ex- resistance. Finally, insulin resistance is characterized by pathway-spe-
lations cific impairment in phosphatidylinositol 3-kinase signaling. In the en-
at pre- dothelium, this may cause an imbalance between the production of
ut not nitric oxide and secretion of endothelin-1, leading to decreased blood
flow. Although these mechanisms are provocative, when insulin action
is assessed by levels of fasting insulin or by the Homeostasis Model As-
liver is sessment (HOMA), insulin resistance contributes only modestly to the
glycer- increased prevalence of hypertension in the metabolic syndrome.
nsulin
