The Wxyz Of Cardiodiab Risk
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THE WXYZ OF CARDIODIAB RISK DR.RISHIKESAN K.V VENNIYIL MED .CENTRE SHARJAH
DIABETES EPIDEMIC
EARLY RECOGNITION OF RISK FACTORS
ENABLES THE CONTROL OF THE PROGRESSION OF THESE FACTORS BY LIFE STYLE CHANGE AND OR MEDICATIONS
LIFE STYLE CHANGES TARGET WEIGHT LOSS AND INCREASED PHYSICAL ACTIVITY
THE MNEMONIC WXYZ
W = THE WEIGHT/WAIST FACTOR X = THE METABOLIC SYNDROME (SYNDROME X ) ASSOCIATED WITH CENTRAL OVERWT. Y = WHY THE PARTICULAR PERSON DEVELOPS THE METABOLIC SYNDROME Z = SLEEP APNOEA, NOT GETTING ENOUGH SLEEP
W – THE WEIGHT/WAIST FACTOR
EACH YEAR OUR WEIGHT AND WAIST GET BIGGER BOTH AS INDIVIDUALS AND AS A POPULATION.
THERE ARE MANY FACTORS – BUT THE BIG TWO ARE _ HIGH ENERGY FOOD
LIFE
_ LOW ENERGY
FACTORS INCREASING WT.&WAIST
THE BIG TWO * EATING MORE * WALKING LESS
POSSIBLE OTHER FACTORS *NOT ENOUGH SLEEP *CLIMATE CONTROL *LESS SMOKING *MEDICATIONS *MATURE MUMS *PRENATAL EFFCTS *POLLUTION *LIKE MARRYING LIKE *FAT EQUALS FECUND
GLOBESITY
Obesity is becoming a global problem. The prevalence of obesity is increasing in Europe, Japan, & China. 10% of Chinese
W
FACTOR
MEN AND WOMEN ARE GETTING HEAVIER AND FATTER WOMEN ARE GAINING .6 KG PER EVERY YEAR AND MEN GAIN .4 KG PER YEAR. THIS W FACTOR CAN BE ASSESSED BY WAIST CIRCUMFERENCE. > 88 CM. FOR WOMEN; > 102 CM FOR MEN
Teleology
Early humans evolved powerful mechanisms for storing & saving energy. They ate as much as possible when they had the chance, stored it as fat. They were energy efficient.
We Are Victims Of Our Success
We still possess the adaptive traits of our Paleolithic ancestors. We are programmed to eat as much as we can & store it as fat. We are still energy efficient. If we had not developed these traits we would have become extinct,
Why Have We Gained So Much Weight?
The current epidemic of obesity is not an epidemic of lack of character. Obesity is a “complex multifactorial chronic disease that develops from an interaction of genotype & environment…it involves the integration of social, behavioral, cultural, physiologic, metabolic & genetic factors”
Starvation Is No Longer A Threat
We can produce large quantities of cheap, convenient, tasty, high calorie food We are extremely good at
THE BIG TWO
THE BIG TWO OF – HIGH ENERGY FOOD AND LOW ENERGY LIFE STYLE: FOR Eg :FAST FOOD , TELEVISION AND COMPUTER WE LIVE IN AN ENVIRONMENT DISPOSING TOWARDS OBESITY HEALTHY LIFESTYLE CHOICES ARE HARD CHOICES
We Don’t Have To Expend Much Energy
We have created conditions that allow us to avoid exertion at work, in travel, & in entertainment. We do little to promote
Our Diet Has Changed
There are more two wage earner families & less time to cook food at home. We eat more fast food. Fast food has been heavily
OTHER SYSTEMATIC FACTORS LEADING TO WT. GAIN SMOKING LESS AND SLEEPING LESS
SEEM TO PREDISPOSE TO WT.GAIN
THE SUCCESS OF QUIT CAMPAIGN MAY BE AT THE PRICE OF A FATTER POPULATION IN MANY COUNTRIES
*Heating and Airconditioning in homes and workplaces have reduced the need for body energy expenditure to keep warm or cold. *Overwt.people tend to have overwt.children
* WOMEN ARE DELAYING HAVING CHILDREN AND OLDER MOTHERS TEND TO HAVE FATTER CHILDREN
* PEOPLE TEND TO BE ATTRACTED TO THOSE WHO ARE LIKE THEM FAT PERSON LIKELY TO MARRY FAT PERSON , POSSIBLY AMPLIFYING INCREASES IN OBESITY
EXPOSURE TO CHEMICALS,
ENVIRONMENTAL POLLUTANTS AND SOME OF THESE CAN LEAD TO WEIGHT GAIN
SOME GROUPS OF PEOPLE ARE FATTER THAN OTHERS OVER THE LAST 40 YEARS OUR SOCIETY HAS CHANGED IN MANY WAYS THAT MAKE IT MORE AND MORE DIFFICULT TO CONTROL THE W FACTOR
WT.AND CVD
EFFECT OF WT.REDUCTION
X = METABOLIC XYNDROME OR SYNDROME X
X= SYNDROME X
CRITERIA WHO/NCEP
ALL DEFINITIONS HAVE 3 COMPONENTS * OVERWT/WAIST * CARDIOVASCULAR RISK * ABNORMAL GLUCOSE METABOLISM
Some Types of Fat Are Worse Than Others
Fat can be distributed all over the body or primarily in the abdomenvisceral fat Visceral fat is associated with the metabolic syndrome: high blood lipids, high blood pressure,
THE TREATABLE COMPONENTS ARE BLOODPRESSURE, BLOOD GLUCOSE, BLOOD FATS AND PROTHROMBOSIS
THE MAJOR FEATURE OF METABOLIC SYN.
PROGRESSIVE NATURE OF OVER WT. AND ASSOCIATED PROBLEMS EPIDEMIOLOGICAL STUDIES SHOW A CONTINUUM OF CARDIOVASCULAR RISK . THERE IS A PROGRESSIVE RISK WITH INCREASING BP , BLOOD SUGAR AND BLOOD FATS
PATHOPHYSIOLOGY METABOLIC SYNDROME
CNS SEEMS TO PLAY A ROLE IN THE RELEASE OF FAT FROM VISCERAL FAT DEPOT VIA SYMP. NS. LIVER & Ms BECOME INSULIN RESISTANT
CHD PREVALENCE
MAJOR FOCUSSHOULD BE ON BEHAVIOURAL THERAPY WT.LOSS REDUCES THE INCIDENC OF CVD BEHAVTHAN METFORMIN .
THE FULL TYPE 2 TABLETS
IT IS NOT CURRENT PRACTICE TO PRESCRIBE FULL TYPE 2 TAB (METFORMIN , ACEI , STATIN , & ASPIRIN ) FOR PEOPLE WITH METSY.
Y = WHY THE PARTICULAR PERSON AT HIGH RISK THE ‘ F ” WORDS ACCOUNT FOR MOST CASES OF METSY. & ITS COMPONENTS *** FORTY : AGE OVER 40 YEARS **** FAMILY H/o TYPE 2 DM IN A 1o RELATIVE ( RISK INCREASING TWO FOLD WITH ONE 1o RELATIVE AND THREE FOLD WITH TWO OR MORE ) **** FAT – OVER WEIGHT / WAIST
NURSES HEALTH STUDY
AS FOR MANY OTHER CHRONIC DISEASES , AGE EMERGED AS A MAJOR RISK FACTOR.
DIABETES RISK INCREASES 10 FOLD BETWEEN THE AGES OF 20 – 60 YEARS.
LIFE TIME RISK , IF NO F H/o DIABETES IS 10%.
THOSE WITH DIABETES ARE RESPONSIBLE FOR THEIR OWN DIABETES
THEY ARE THE LAZY GLUTTONS WHO ARE SUFFERING FROM THEIR SELF INDULGENCE . IT IS TRUE THAT AGE AND GENES ARE FIXED AND THE FATNESS TO SOME DEGREE UNDER THE INDIVIDUALs CONTROL
Z = SLEEP APNOEA SLEEP APNOEA & LACK OF ZZZ….s IS OFTEN ASSOCIATED WITH OTHER CARDIO DIAB FACTORS . OSA CAN PREDISPOSE TO INCREASING WEIGHT AND WAIST AND TO THE WORSENING OF THE METABOLIC ABNORMALITIES ASSOC. WITH SYNDROME X
OSA
OSA CAUSES SLEEP DISTURBANCE RESULTS IN ACTIVTION OF HPA AXIS AND THE SYMPATHETIC RESPONSE . DISTURBED SLEEP CAN LEAD TO DAY TIME SLEEPINESS . THE COMBINTION OF NOCTURNAL HORMONE DISTURBANCE AND DAYTIME LETHARGY AGGRAVATES ADVERSE RISK FACTOR PROFILE
LACK OF
ZZZ…….
WORSENS THE METABOLIC PROFILE AGGRAVATES DAYTIME SLEEPINESS REDUCES THE MOTIVATION REDUCES THE CAPACITY FOR LIFE STYLE CHANGES NECK CIRCUMFERENCE (> 42 CM . ) OR A HIGH EPWORTH SLEEPINESS SCORE IDENTIFY THE PERSON AT RISK
EPWORTH SLEEPINESS SCALE
HOW LIKELY ARE YOU TO DOZE OFF / FALL ASLEEP IN CERTAIN SITUATIONS
MEASURE DAY TIME SLEEPINESS.
DISTINGUISH NORMAL SUBJECTS FROM PATIENTS WITH VARIOUS CONDITIONS LIKE * OSA , * NARCOLEPSY ,
ESS SCORE ILLUSTRATED
0 - 10 NORMAL RANGE
10 - 12 BORDERLINE
12 - 24 ABNORMAL
OSA AND CPAP
CPAP CAN DO WONDERS IN PEOPLE HAVING OSA. RESULTS DRAMATIC – WEIGHT AND WAIST LOSS REDUCES BP & BLOOD SUGAR LOSS OF BLOOD FATS INCREASES IN WELL BEING
CONCLUSIONS
EARLY RECOGNITION OF THE RISK FACTORS ENABLES CONTROL OF THE PROGRESSION OF THESE FACTORS BY LIFE STYLE CHANGES , MEDICATIONS OR BOTH . THE MNEMONIC WXYZ PROVIDES A USEFUL APPROACH WHEN CONSIDERING THESE CARDIODIAB RISKS.
DIABETES EPIDEMIC
EARLY RECOGNITION OF RISK FACTORS
ENABLES THE CONTROL OF THE PROGRESSION OF THESE FACTORS BY LIFE STYLE CHANGE AND OR MEDICATIONS
LIFE STYLE CHANGES TARGET WEIGHT LOSS AND INCREASED PHYSICAL ACTIVITY
THE MNEMONIC WXYZ
W = THE WEIGHT/WAIST FACTOR X = THE METABOLIC SYNDROME (SYNDROME X ) ASSOCIATED WITH CENTRAL OVERWT. Y = WHY THE PARTICULAR PERSON DEVELOPS THE METABOLIC SYNDROME Z = SLEEP APNOEA, NOT GETTING ENOUGH SLEEP
W – THE WEIGHT/WAIST FACTOR
EACH YEAR OUR WEIGHT AND WAIST GET BIGGER BOTH AS INDIVIDUALS AND AS A POPULATION.
THERE ARE MANY FACTORS – BUT THE BIG TWO ARE _ HIGH ENERGY FOOD
LIFE
_ LOW ENERGY
FACTORS INCREASING WT.&WAIST
THE BIG TWO * EATING MORE * WALKING LESS
POSSIBLE OTHER FACTORS *NOT ENOUGH SLEEP *CLIMATE CONTROL *LESS SMOKING *MEDICATIONS *MATURE MUMS *PRENATAL EFFCTS *POLLUTION *LIKE MARRYING LIKE *FAT EQUALS FECUND
GLOBESITY
Obesity is becoming a global problem. The prevalence of obesity is increasing in Europe, Japan, & China. 10% of Chinese
W
FACTOR
MEN AND WOMEN ARE GETTING HEAVIER AND FATTER WOMEN ARE GAINING .6 KG PER EVERY YEAR AND MEN GAIN .4 KG PER YEAR. THIS W FACTOR CAN BE ASSESSED BY WAIST CIRCUMFERENCE. > 88 CM. FOR WOMEN; > 102 CM FOR MEN
Teleology
Early humans evolved powerful mechanisms for storing & saving energy. They ate as much as possible when they had the chance, stored it as fat. They were energy efficient.
We Are Victims Of Our Success
We still possess the adaptive traits of our Paleolithic ancestors. We are programmed to eat as much as we can & store it as fat. We are still energy efficient. If we had not developed these traits we would have become extinct,
Why Have We Gained So Much Weight?
The current epidemic of obesity is not an epidemic of lack of character. Obesity is a “complex multifactorial chronic disease that develops from an interaction of genotype & environment…it involves the integration of social, behavioral, cultural, physiologic, metabolic & genetic factors”
Starvation Is No Longer A Threat
We can produce large quantities of cheap, convenient, tasty, high calorie food We are extremely good at
THE BIG TWO
THE BIG TWO OF – HIGH ENERGY FOOD AND LOW ENERGY LIFE STYLE: FOR Eg :FAST FOOD , TELEVISION AND COMPUTER WE LIVE IN AN ENVIRONMENT DISPOSING TOWARDS OBESITY HEALTHY LIFESTYLE CHOICES ARE HARD CHOICES
We Don’t Have To Expend Much Energy
We have created conditions that allow us to avoid exertion at work, in travel, & in entertainment. We do little to promote
Our Diet Has Changed
There are more two wage earner families & less time to cook food at home. We eat more fast food. Fast food has been heavily
OTHER SYSTEMATIC FACTORS LEADING TO WT. GAIN SMOKING LESS AND SLEEPING LESS
SEEM TO PREDISPOSE TO WT.GAIN
THE SUCCESS OF QUIT CAMPAIGN MAY BE AT THE PRICE OF A FATTER POPULATION IN MANY COUNTRIES
*Heating and Airconditioning in homes and workplaces have reduced the need for body energy expenditure to keep warm or cold. *Overwt.people tend to have overwt.children
* WOMEN ARE DELAYING HAVING CHILDREN AND OLDER MOTHERS TEND TO HAVE FATTER CHILDREN
* PEOPLE TEND TO BE ATTRACTED TO THOSE WHO ARE LIKE THEM FAT PERSON LIKELY TO MARRY FAT PERSON , POSSIBLY AMPLIFYING INCREASES IN OBESITY
EXPOSURE TO CHEMICALS,
ENVIRONMENTAL POLLUTANTS AND SOME OF THESE CAN LEAD TO WEIGHT GAIN
SOME GROUPS OF PEOPLE ARE FATTER THAN OTHERS OVER THE LAST 40 YEARS OUR SOCIETY HAS CHANGED IN MANY WAYS THAT MAKE IT MORE AND MORE DIFFICULT TO CONTROL THE W FACTOR
WT.AND CVD
EFFECT OF WT.REDUCTION
X = METABOLIC XYNDROME OR SYNDROME X
X= SYNDROME X
CRITERIA WHO/NCEP
ALL DEFINITIONS HAVE 3 COMPONENTS * OVERWT/WAIST * CARDIOVASCULAR RISK * ABNORMAL GLUCOSE METABOLISM
Some Types of Fat Are Worse Than Others
Fat can be distributed all over the body or primarily in the abdomenvisceral fat Visceral fat is associated with the metabolic syndrome: high blood lipids, high blood pressure,
THE TREATABLE COMPONENTS ARE BLOODPRESSURE, BLOOD GLUCOSE, BLOOD FATS AND PROTHROMBOSIS
THE MAJOR FEATURE OF METABOLIC SYN.
PROGRESSIVE NATURE OF OVER WT. AND ASSOCIATED PROBLEMS EPIDEMIOLOGICAL STUDIES SHOW A CONTINUUM OF CARDIOVASCULAR RISK . THERE IS A PROGRESSIVE RISK WITH INCREASING BP , BLOOD SUGAR AND BLOOD FATS
PATHOPHYSIOLOGY METABOLIC SYNDROME
CNS SEEMS TO PLAY A ROLE IN THE RELEASE OF FAT FROM VISCERAL FAT DEPOT VIA SYMP. NS. LIVER & Ms BECOME INSULIN RESISTANT
CHD PREVALENCE
MAJOR FOCUSSHOULD BE ON BEHAVIOURAL THERAPY WT.LOSS REDUCES THE INCIDENC OF CVD BEHAVTHAN METFORMIN .
THE FULL TYPE 2 TABLETS
IT IS NOT CURRENT PRACTICE TO PRESCRIBE FULL TYPE 2 TAB (METFORMIN , ACEI , STATIN , & ASPIRIN ) FOR PEOPLE WITH METSY.
Y = WHY THE PARTICULAR PERSON AT HIGH RISK THE ‘ F ” WORDS ACCOUNT FOR MOST CASES OF METSY. & ITS COMPONENTS *** FORTY : AGE OVER 40 YEARS **** FAMILY H/o TYPE 2 DM IN A 1o RELATIVE ( RISK INCREASING TWO FOLD WITH ONE 1o RELATIVE AND THREE FOLD WITH TWO OR MORE ) **** FAT – OVER WEIGHT / WAIST
NURSES HEALTH STUDY
AS FOR MANY OTHER CHRONIC DISEASES , AGE EMERGED AS A MAJOR RISK FACTOR.
DIABETES RISK INCREASES 10 FOLD BETWEEN THE AGES OF 20 – 60 YEARS.
LIFE TIME RISK , IF NO F H/o DIABETES IS 10%.
THOSE WITH DIABETES ARE RESPONSIBLE FOR THEIR OWN DIABETES
THEY ARE THE LAZY GLUTTONS WHO ARE SUFFERING FROM THEIR SELF INDULGENCE . IT IS TRUE THAT AGE AND GENES ARE FIXED AND THE FATNESS TO SOME DEGREE UNDER THE INDIVIDUALs CONTROL
Z = SLEEP APNOEA SLEEP APNOEA & LACK OF ZZZ….s IS OFTEN ASSOCIATED WITH OTHER CARDIO DIAB FACTORS . OSA CAN PREDISPOSE TO INCREASING WEIGHT AND WAIST AND TO THE WORSENING OF THE METABOLIC ABNORMALITIES ASSOC. WITH SYNDROME X
OSA
OSA CAUSES SLEEP DISTURBANCE RESULTS IN ACTIVTION OF HPA AXIS AND THE SYMPATHETIC RESPONSE . DISTURBED SLEEP CAN LEAD TO DAY TIME SLEEPINESS . THE COMBINTION OF NOCTURNAL HORMONE DISTURBANCE AND DAYTIME LETHARGY AGGRAVATES ADVERSE RISK FACTOR PROFILE
LACK OF
ZZZ…….
WORSENS THE METABOLIC PROFILE AGGRAVATES DAYTIME SLEEPINESS REDUCES THE MOTIVATION REDUCES THE CAPACITY FOR LIFE STYLE CHANGES NECK CIRCUMFERENCE (> 42 CM . ) OR A HIGH EPWORTH SLEEPINESS SCORE IDENTIFY THE PERSON AT RISK
EPWORTH SLEEPINESS SCALE
HOW LIKELY ARE YOU TO DOZE OFF / FALL ASLEEP IN CERTAIN SITUATIONS
MEASURE DAY TIME SLEEPINESS.
DISTINGUISH NORMAL SUBJECTS FROM PATIENTS WITH VARIOUS CONDITIONS LIKE * OSA , * NARCOLEPSY ,
ESS SCORE ILLUSTRATED
0 - 10 NORMAL RANGE
10 - 12 BORDERLINE
12 - 24 ABNORMAL
OSA AND CPAP
CPAP CAN DO WONDERS IN PEOPLE HAVING OSA. RESULTS DRAMATIC – WEIGHT AND WAIST LOSS REDUCES BP & BLOOD SUGAR LOSS OF BLOOD FATS INCREASES IN WELL BEING
CONCLUSIONS
EARLY RECOGNITION OF THE RISK FACTORS ENABLES CONTROL OF THE PROGRESSION OF THESE FACTORS BY LIFE STYLE CHANGES , MEDICATIONS OR BOTH . THE MNEMONIC WXYZ PROVIDES A USEFUL APPROACH WHEN CONSIDERING THESE CARDIODIAB RISKS.
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