1. Metabolic syndrome from a gender and cardiovascular perspective Eva Swahn

2. IDF Worldwide Definition of the Metabolic Syndrome (2005) The metabolic syndrome is a cluster of the most dangerous heart attack risk factors: diabetes and prediabetes, abdominal obesity, high cholesterol and high blood pressure. A quarter of the world’s adults have metabolic syndrome People with metabolic syndrome are twice as likely to die from, and three times as likely to have a heart attack or stroke compared with people without the syndrome People with metabolic syndrome have a five-fold greater risk of developing type 2 diabetes Up to 80% of the 200 million people with diabetes globally will die of cardiovascular disease

3. Cardiovascular disease Classical Risk Factors Novel Risk Factors Metabolic syndrome T2DM  Smoking  LDL-C  BP Abdominal Obesity  HDL-C  TG  TNF  IL-6  PAI-1  Glu  Insulin Cancer

5. Definition Waist in cm Women >80 obs Women >88 action Men >94 obs Men >102 action Prevention of coronary heart disease in clinical practice. Eur Heart Journal 1998;19:1434-1503 Waist in cm Women >8069% Women >88 42% Men >94 64% Men >102 32% Waist in cm Women >8069% Women >88 42% Men >94 64% Men >102 32% Abdominal obesity in Stockholm people (60 years old)

6. Health threat from abdominal obesity is largely due to intra-abdominal obesity Abdominal Obesity Dyslipidemia Hypertension Glucose Intolerance Insulin Resistance Increased Cardiometabolic Risk Intra-Abdominal Adiposity Adapted from Eckel et al 2005

7. Nurses Health Study, 88 393 women, 34-59 years followed for 20 years, 1980-2000, healthy at study start. Risk to get heart disease Abdominal obesity Overweight The importance of abdominal obesity on the risk to get myocardial infarction Tricia Y.Li et al. Circulation 2006;113:499-506

9. Copenhagen city heart study EHJ (2002) 23, 620-626

10. Smoking Diabetes Psycosocial factors High lipids Food AlcoholHigh bloodpressure Overweight Abdominal obesity Thrombogenic factors coagulation / fibrinolysis Physical activity HeredityInfection Inflammation Interheart Yusuf S et al, Lancet 2004;364:937-52

11. 3.6 mmol/l 0.8 g/l 3.6 mmol/l 1.5 g/l LDL apoB apo B Large buoyantSmall dense © G.Walldius, I. Jungner

12. Interheart Odds ratio for myocardial infarction depending on quintiles for apoB/apoA-I (after adjusting for other risk factors). Yussuf S et al, Lancet -04 OR apoB/apoA-I

13. apoB and LDL – relation to sex

14. Oldfashioned mediterranean food

15. MooreLess

16. Levine JA et al. Am J Clin Nutr 2000;72:1451 Energy use kJ/min

18. One cigarette shortens life with 2 min. One beer shortens life with 4 min. One working day shortens life with 8 hours!!!