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ΚΑΡΔΙΑΓΓΕΙΑΚΗ ΝΟΣΗΡΟΤΗΤΑ/ΘΝΗΤΟΤΗΤΑ ΣΕ ΠΑΧΥΣΑΡΚΙΑ ΜΕ Η ΧΩΡΙΣ Σ.Α.Υ. Ι. Νικολόπουλος Πνευμονολόγος ΚΑΑ/ΜΕΘ «ΣΩΤΗΡΙΑ»

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Presentation on theme: "ΚΑΡΔΙΑΓΓΕΙΑΚΗ ΝΟΣΗΡΟΤΗΤΑ/ΘΝΗΤΟΤΗΤΑ ΣΕ ΠΑΧΥΣΑΡΚΙΑ ΜΕ Η ΧΩΡΙΣ Σ.Α.Υ. Ι. Νικολόπουλος Πνευμονολόγος ΚΑΑ/ΜΕΘ «ΣΩΤΗΡΙΑ»"— Presentation transcript:

1 ΚΑΡΔΙΑΓΓΕΙΑΚΗ ΝΟΣΗΡΟΤΗΤΑ/ΘΝΗΤΟΤΗΤΑ ΣΕ ΠΑΧΥΣΑΡΚΙΑ ΜΕ Η ΧΩΡΙΣ Σ.Α.Υ. Ι. Νικολόπουλος Πνευμονολόγος ΚΑΑ/ΜΕΘ «ΣΩΤΗΡΙΑ»

2 Int. J. Obes. Relat. Metab. Disord. 2002

3 “These associated conditions are responsible for more than 2.5 million deaths per year worldwide.” Buchwald H, Avidor Y et al. JAMA 2004;292(14)

4 Cardiovascular Consequences of obesity 1)Hypertension 2)Atrial Fibrillation (AF) 3)Atherosclerosis and CAD 4)Heart Failure 5)Pulmonary Embolism/DVT 6)Stroke 7)Sudden Cardiac Death Am. Heart J. 2008 ; 155 : 310

5 Παχυσαρκία και Καρδιαγγειακή νοσηρότητα 1) Συστηματική φλεγμονή ( CRP, IL-6... ) 2) Αυξημένα επίπεδα λεπτίνης και αντίσταση. «independent risk factors for CVD» ( PLT aggregation, δραστηριότητα συμπαθητικού, αντίσταση σε ινσουλίνη) 3) Αντίσταση στην ινσουλίνη (Διαβήτης, Δυσλιπιδαιμία, Διαταραχές πηκτικότητας, Δυσλειτουργία ενδοθηλίου, αθηροσκλήρωση, δραστηριότητα συμπαθητικού) 4) Δυσλιπιδαιμία ( Τριγλυκερίδια, HDL) 5) Αιμοδυναμικές διαταραχές ( όγκος αίματος, καρδιακή παροχή, καρδιακό έργο, πιέσεις και όγκοι πλήρωσης κοιλιών, διάταση και υπερτροφία κοιλιών, διάταση αριστερού κόλπου) ΜΗΧΑΝΙΣΜΟΙ Am. Heart J. 2008 ; 155 : 310

6 BMC Public health 2009, 9:88 “89 relevant studies” follow up 12.5 years “Statistically significant associations with obesity were found with all cardiovascular diseases.”

7

8 “40% higher ischaemic mortality for every 5kg/m2 higher BMI” “40% higher stroke mortality for every 5kg/m2 higher BMI”

9 “30% higher mortality for every 5kg/m2 higher BMI”

10 JAMA 2004;272 : 2471-2477

11 AF and obesity-results of a meta-analysis Am. Heart J. 2008;155 : 310-315 Relationship between BMI and risk of Atrial Fibrillation in general population 123.249 Patients

12 Stein PD et al Obesity as a risk factor in venous thromboembolism (1979-1999) Am. J. Med 2005 >12.000.000 hospitalized patients in USA RR for PE: 2.18 RR for DVT: 2.50

13 Alpert M, Terry B et al Am. J. Cardiol. 1997;80(6):736-40 “Duration of morbid obesity is one of the strongest predictors of heart failure ” 20 years: 66% probability – 25 years: 93% probability

14 Hypertension. 2005;46:654-659 139.562 men and 104.236 women – follow up period: 25 years

15 Hypertension. 2005;46:654-659 CVD mortality according to BMI and associated risk factors

16 Med. Clin. North Am 2010 May 94(3) “Combination of OSA and obesity possibly increases the risk for cardiovascular disorders.”

17 Peters RW. OSA and Cardiovascular Disease Chest 2005;127.

18 “ Obesity and OSA often coexist: >40% of obese pts have significant OSA 70% of OSA pts are obese ” “ A 10% increase in weight gain is associated with a 6-fold increase in the odds of developing OSA. … every 6 kg/m2 increment in BMI increases OSA risk, more than 4-fold. ” Lancet 2002 Sleep Heart Health Study. Arch. Intern Med. 2002 Diabetes Obesity and Metabolism 2006

19 “ Obese OSA patients can potentially be at higher risk for cardiovascular morbidity and mortality… …this will need to be addressed in future prospective studies. ” “…OSA in obese patients may place them at higher risk for cardiovascular outcomes than obese patients without OSA, though such assertions await firm clinical evidence. ” “…unfortunately most studies in obese patients did not assess for OSA and exclude it as a possible confounder. ” CHEST 2000;118:580-586 Kannan Ramar, Sean Caples. Med. Clin. North Am. 2010

20 MSNA: Muscle sympathetic nerve activity Circulation 1998(98) 772-776 Diabetes, Obesity and Metabolism, 8, 2006, 250-260 “obesity alone is not accompanied by any clear increase in sympathetic activity to muscle blood vessels,unless it is accompanied by OSA. ”

21 The impact of obesity on Oxygen Desaturation during sleep-disordered breathing Am. J. Crit. Care Med. 2009;180:788-793

22 The impact of obesity on Oxygen Desaturation during sleep-disordered breathing Am. J. Crit. Care Med. 2009;180:788-793 men women

23 CHEST 2000;118:580-586 “Serum leptin levels correlated positively with BMI, skinfold thickness, apnea-hypopnea index, and oxygen desaturation time. ” “…OSA in obese patients may place them at higher risk for cardiovascular outcomes than obese patients without OSA. ”

24 “Increased CRP in obesity may be related not simply to increased adiposity per se, but also to coexisting OSA.” Circulation 2003(107)

25 “Studies of OSA in obesity may provide important insights into unexplained clinical observations, such as why only a subgroup of obese patients develop insulin resistance, and cardiovascular disease.” Diabetes Obes Metab 2006

26 ΕΥΧΑΡΙΣΤΩ !


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