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Atlas of Cardiometabolic Risk - W. Cefalu, et. al., (Informa, 2007) WW PDF

172 Pages·2007·9.13 MB·English
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Atlas of CARDIOMETABOLIC RISK Cefalu Prelims 1/30/07 6:27 PM Page 1 Cefalu Prelims 1/30/07 6:27 PM Page 2 Atlas of CARDIOMETABOLIC RISK William T Cefalu MD Professor and Chief, Division of Nutrition and Chronic Diseases Pennington Biomedical Research Center Louisiana State University System Baton Rouge, Louisiana, USA and Christopher P Cannon MD Senior Investigator, Thrombolysis in Myocardial Infarction (TIMI) Study Group Cardiovascular Division, Brigham and Women’s Hospital Associate Professor of Medicine, Harvard Medical School Boston, Massachusetts, USA Foreword by Eugene Braunwald MD Cefalu Prelims 1/30/07 6:27 PM Page 3 Informa Healthcare USA, Inc. 270 Madison Avenue New York, NY 10016 © 2007 by Informa Healthcare USA, Inc. Informa Healthcare is an Informa business No claim to original US Government works Printed in the United States of America on acid-free paper 10 9 8 7 6 5 4 3 2 1 International Standard Book Number-10: 0-8493-7053-1 (Hardcover) International Standard Book Number-13: 978-0-8493-7053-3 (Hardcover) This book contains information obtained from authentic and highly regarded sources. Reprinted material is quoted with permission, and sources are indicated. A wide variety of references are listed. Reasonable efforts have been made to publish reliable data and information, but the author and the publisher cannot assume responsibility for the validity of all materials or for the consequences of their use. No part of this book may be reprinted, reproduced, transmitted, or utilized in any form by an electronic, mechanical, or other means, now known or hereafter invented, including photocopying, microfilming, and recording, or in any information storage or retrieval system, without written permission from the publishers. For permission to photocopy or use material electronically from this work, please access www.copyright.com (http://www.copyright.com/) or contact the Copyright Clearance Center, Inc. (CCC) 222 Rosewood Drive, Danvers, MA 01923, 978-750-8400. CCC is a not-for-profit organization that provides licenses and registration for a variety of users. For organizations that have been granted a photocopy license by the CCC, a separate system of payment has been arranged. Trademark Notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without intent to infringe. Visit the Informa Web site at www.informa.com and the Informa Healthcare Web site at www.informahealthcare.com Cover illustrations courtesy of: GA Bray, GBM Lindop, IN Scobie, PF Semple and HC Stary Cefalu Prelims 1/30/07 6:27 PM Page 4 5 At the beginning of the twentieth century cardiovascular disease was responsible for approximately 10% of all deaths in the United States. During the first half of the century, with urbanization and the transition from a largely agricultural to an industrial economy, the percentage of deaths due to cardiovascular disease rose rapidly to about 35%, becoming the most common cause of mortality in the United States and, indeed, in the entire industrialized world. By mid-century, the recognition that an acute coronary event is not “a bolt out of the blue” but often occurs in susceptible patients in whom the classic coronary risk factors of hypercholesterolemia, hypertension, and/or smoking had been present sparked an interest in preventive measures. The development of coronary care units, coronary revascularization, as well as antihypertensive and cholesterol-reducing agents first stopped the steady rise in cardiovascular deaths and then delayed such deaths substantially. By the beginning of the last decade of the century it appeared that the tide had turned and that, at last, atherosclerotic vascular disease was beginning to come under control. However, despite this encouraging progress, all was not well. With the transition from the industrial economy to an information-service economy, the wide availability and popularity of very high caloric, fast foods (the “McDonald’s culture”) and the reduction in physical activity, the twin epidemics of type 2 diabetes and obesity began to grow at an alarming rate. The percentage of the population that is overweight or obese has risen by 5% per decade since 1960, and the percentage with diabetes has almost doubled in just the last ten years. A cluster of risk factors, including but not limited to insulin resistance, central obesity, dyslipidemia, impaired glucose tolerance, essential hypertension and inflammation is associated with a state of increased cardiometabolic risk that is now present in at least one quarter of the adult population. As we approach the end of the first decade of the twenty-first century, the seeming relentless rise in cardiometabolic risk threatens to reverse the earlier progress in the battle against atherosclerotic coronary and non-coronary vascular disease. In order to control cardiometabolic risk we must first understand this cluster of risk factors and examine the several modes of prevention and treatment that are now or will soon be at our disposal. Dr Cefalu, an expert on metabolic diseases, and Dr Cannon, a cardiologist, have teamed up with a group of talented authors to prepare this splendid Atlas of Cardiometabolic Risk. The excellent explanatory diagrams and the lucid accompanying text provide the reader with the knowledge required to engage in this next critical battle against atherosclerotic cardiovascular disease. Eugene Braunwald, MD Brigham and Women’s Hospital Harvard Medical School Boston, MA Foreword Cefalu Prelims 1/30/07 6:27 PM Page 5 Cefalu Prelims 1/30/07 6:27 PM Page 6 7 Cardiovascular disease is the leading cause of death and disability worldwide. Although our understanding of this disease has progressed enormously, we have much to improve in identification of the disease and applying optimal treatments to prevent progression of disease and its consequences. Beginning nearly 50 years ago, the Framingham Heart Study forever changed our approach to coro- nary artery disease by identifying major risk factors for myocardial infarction (MI) – namely hypertension, smoking, hypercholesterolemia, diabetes and a family history of MI. Since then, countless other risk factors and markers of disease have been identified. Our cur- rent approach to prevention (either primary preven- tion of a first event, or secondary prevention of recurrent events) is largely focused on controlling these individual risk factors. This single risk factor approach has led to multiple classes of drugs to treat each condition, and guidelines are developed centered on improvements of each one (e.g., hypertension – JNC VII, or the ADA) In addition, decades ago, the United States government established national pro- grams, such as the National Cholesterol Education Program (NCEP) that develops guidelines for manage- ment of cholesterol. A new approach is emerging however – that looks not at individual risk factors, but at the overall risk of disease in a patient. This involves looking at a long list of contributing risk factors – to assess a patient's over- all cardiometabolic risk. It is this new approach to diagnosis and management that this book embraces. We aim to provide the best possible care to our patients, and taking this comprehensive approach is the best strategy to do so. We cover many aspects of cardiometabolic risk in this Atlas. The initial chapters delve into the new understanding of the pathophysiology of the cardio- metabolic risk, with colorful illustrations of the various pathways involved. Then, we cover many of the mark- ers of cardiometabolic risk that can be used to identi- fy patients in clinical practice. The final chapters review the newest trial data on the natural history of the disease with clinical outcomes of patients, as well as a brief overview of all the current treatments for cardiometabolic risk. We hope that this book will pro- vide clinicians with a readily accessible guide to this important disease, that will help in caring for this large group of patients. Christopher P Cannon, MD William T Cefalu, MD Preface Cefalu Prelims 1/30/07 6:27 PM Page 7 Cefalu Prelims 1/30/07 6:27 PM Page 8 9 Contents Foreword – Eugene Braunwald 5 Preface 7 Contributors 11 1 Classification and evolution of increased cardiometabolic risk states 13 William T Cefalu 2 Insulin resistance and cardiometabolic risk 27 William T Cefalu 3 Role of obesity and body fat distribution in cardiometabolic risk 39 William T Cefalu 4 Physiologic systems regulating energy balance, including the EC system 55 William T Cefalu 5 Traditional metabolic risk factors 69 Kausik K Ray, Christopher P Cannon 6 Non-traditional risk factors of cardiometabolic risk 87 Kausik K Ray, Christopher P Cannon 7 Clinical outcomes of patients with cardiometabolic risk factors 105 Gregory Piazza, Christopher P Cannon 8 Managing cardiometabolic risk – a brief review 137 Benjamin A Steinberg, Christopher P Cannon Index 167 Cefalu Prelims 1/30/07 6:27 PM Page 9

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