Presentation on theme: "Grazie per aver scelto di utilizzare a scopo didattico questo materiale delle Guidelines 2011 libra. Le ricordiamo che questo materiale è di proprietà."— Presentation transcript:
Grazie per aver scelto di utilizzare a scopo didattico questo materiale delle Guidelines 2011 libra. Le ricordiamo che questo materiale è di proprietà dell’autore e fornito come supporto didattico per uso personale.
Diabetes obesity in patients with COPD Angelo Avogaro
Atherogenic dyslipidemia Triglycerides HDL-cholesterol Cholesterol/HDL-cholesterol ratio "Normal" LDL-cholesterol but apo B Small, dense LDL and HDL Postprandial hyperlipidemia Insulin resistance Hyperinsulinemia Hyperglycemia Type 2 diabetes Thrombotic state PAI-1 Fibrinogen Inflammatory state CRP Cytokines risk of acute coronary syndrome Metabolic risk factorsAbdominal obesity Inflammation Lipid core Thin fibrous cap CORONARY ATHEROSCLEROSIS UNSTABLE PLAQUE Intra-abdominal Obesity, Metabolic Risk Factors and CHD adapted from Despres, 2004
Adverse cardiometabolic effects of products of adipocytes Adipose tissue ↑ IL-6 ↓ Adiponectin ↑ Leptin ↑ TNF α ↑ Adipsin (Complement D) ↑ Plasminogen activator inhibitor-1 (PAI-1) ↑ Resistin ↑ FFA ↑ Insulin ↑ Agiotensinogen ↑ Lipoprotein lipase ↑ Lactate Inflammation Type 2 diabetes Hypertension Atherogenic dyslipidaemia Thrombosis Atherosclerosis Lyon 2003; Trayhurn et al 2004; Eckel et al 2005
COPD Inflammation May Contribute to Cardiovascular Disease Rennard. Proc Am Thorac Soc. 2005;2:94-100.
38 COPD patients (age: 66 +/- 7 years, [mean +/- SD], FEV1: 43 +/- 16% 34 control participants matched for age and gender are included in this study. RESULTS: 47% of COPD patients and 21% of control participants presented metabolic syndrome. CONCLUSIONS: The presence of metabolic syndrome is frequent in patients with COPD who participated in a cardiopulmonary program. Hence, this population should be considered for screening for the metabolic syndrome. Marquis K et al, J Cardiopulm Rehabil. 2005 The metabolic syndrome in patients with chronic obstructive pulmonary disease
Log-transformed (log) hs-CRP (A), log interleukin-6 (B), fibrinogen (C), and physical activity level (D) according to GOLD stages and the absence or presence of the metabolic syndrome. Watz H et al. Chest 2009;136:1039-1046
van Buul, J. D. et al. Arterioscler Thromb Vasc Biol 2004;24:824-833 Schematic overview of the distinct steps that comprise leukocyte transendothelial migration
Cardiovascular Health Risk Factors Rescue Factors HDL cholesterol Anti oxidant reserves Endothelial progenitor cells Cigarette smoking Diabetes Mellitus Hypercholesterolemia Hypertension Obesity Age Family history of CVD Gender Postprandial Hyperglycemia
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