Obesity , Metabolic Syndrome and Diabetes in Hispanics: implications on Cardiovascular Disease 2011 Eduardo de Marchena M.D., F.A.C.C., F.A.C.P. Professor of Medicine & Surgery Associate Dean for International Medicine & Director International Medicine Institute Director of Cardiovascular Center University of Miami Miller School of Medicine Obesity Trends* Among U.S. Adults BRFSS, 1985 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% Obesity Trends* Among U.S. Adults BRFSS, 1986 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% Obesity Trends* Among U.S. Adults BRFSS, 1987 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% Obesity Trends* Among U.S. Adults BRFSS, 1988 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% Obesity Trends* Among U.S. Adults BRFSS, 1989 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% Obesity Trends* Among U.S. Adults BRFSS, 1990 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% Obesity Trends* Among U.S. Adults BRFSS, 1991 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% Obesity Trends* Among U.S. Adults BRFSS, 1992 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% Obesity Trends* Among U.S. Adults BRFSS, 1993 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% Obesity Trends* Among U.S. Adults BRFSS, 1994 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% Obesity Trends* Among U.S. Adults BRFSS, 1995 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% Obesity Trends* Among U.S. Adults BRFSS, 1996 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% Obesity Trends* Among U.S. Adults BRFSS, 1997 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20% Obesity Trends* Among U.S. Adults BRFSS, 1998 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20% Obesity Trends* Among U.S. Adults BRFSS, 1999 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20% Obesity Trends* Among U.S. Adults BRFSS, 2000 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20% Obesity Trends* Among U.S. Adults BRFSS, 2001 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25% Obesity Trends* Among U.S. Adults BRFSS, 2002 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25% Obesity Trends* Among U.S. Adults BRFSS, 2003 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25% Obesity Trends* Among U.S. Adults BRFSS, 2004 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25% Obesity Trends* Among U.S. Adults BRFSS, 2005 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% Obesity Trends* Among U.S. Adults BRFSS, 2006 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% Obesity Trends* Among U.S. Adults BRFSS, 2007 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% Obesity Trends* Among U.S. Adults BRFSS, 2008 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% Obesity Trends* Among U.S. Adults BRFSS, 2009 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% “Globesity” Colombia and Brazil 40% women in 2001 Prevalence of Obesity in Males Prevalence of Obesity in Females “Globesity” Alarming trend for Obesity in Children Evolution of Man Diet 2.5 million years Exercise 50 years 2050 New Concept of Ideal Body Type Number and Percentage of U.S. Population with Diagnosed Diabetes, 1958-2008 7 20 6 Percent with Diabetes 16 Percent with Diabetes Number with Diabetes 5 14 12 4 10 3 8 6 2 4 1 2 0 0 1958 61 64 67 70 73 76 79 82 85 88 91 94 97 00 03 06 Year CDC’s Division of Diabetes Translation. National Diabetes Surveillance System available at http://www.cdc.gov/diabetes/statistics Number with Diabetes (Millions) 18 However, the prevalence of chronic diseases such as diabetes is rising, due to population aging but also to changes in lifestyle Prevalence estimates of diabetes, adults aged 20-79 years, 2010 Note: The data are age-standardised to the World Standard Population. Source: International Diabetes Federation (IDF) (2009), “Diabetes Atlas, 4th edition”. Age-adjusted Percentage of U.S. Adults Who Were Obese or Who Had Diagnosed Diabetes Obesity (BMI ≥30 kg/m2) 1994 No Data <14.0% 2008 2000 14.0-17.9% 18.0-21.9% 22.0-25.9% >26.0% Diabetes 1994 No Data 2008 2000 <4.5% 4.5-5.9% 6.0-7.4% 7.5-8.9% CDC’s Division of Diabetes Translation. National Diabetes Surveillance System available at http://www.cdc.gov/diabetes/statistics >9.0% State-specific Prevalence of Obesity* Among U.S. Adults, by Race/Ethnicity, 2006-2008 Black nonWhite non-Hispanic Hispanic (*BMI 30) Hispanic Percent of Population Prevalence of Physician Diagnosed Type 2 diabetes in Adults age 20+ by Race/Ethnicity, and Years of Education (NHANES: 2003-2006). Source: NCHS and NHLBI. NH – nonHispanic. 18 16 14 12 10 8 6 4 2 0 13.4 15.3 13.0 12.8 11.0 9.2 9.6 6.2 5.8 NH Whites NH Blacks Less than high school High school Mexican Americans More than high school Prevalence of Diabetes Today However, the prevalence of chronic diseases such as diabetes is rising, due to population aging but also to changes in lifestyle Prevalence estimates of diabetes, adults aged 20-79 years, 2010 Note: The data are age-standardised to the World Standard Population. Source: International Diabetes Federation (IDF) (2009), “Diabetes Atlas, 4th edition”. Global projection for the Diabetes Epidemic: 2003 – 2025 (millions) Diabetes Caused by Excessive Weight per Global Region The Increased Atherosclerosis Risk in Type 2 Diabetes Begins in the Prediabetic State Clinical Diagnosis Glucose (mg/dL) % Relative to Normal 350 300 250 200 150 100 Postprandial glucose Fasting glucose 200 mg/dl 126 mg/dl Insulin resistance 250 200 150 100 At risk for 50 diabetes b-cell dysfunction Insulin level 0 30 5 10 15 20 25 -10 -5 0 Years Interrelationship Between Insulin Resistance, Abdominal Obesity and Atherosclerosis Insulin Resistance Obesity Hyperglycemia H/T Hypertriglyceridemia Small LDL Low HDL Hypercoagulability Pro-inflammatory Atherosclerosis Endothel. dysfunctn Hyperinsulinemic mitogenesis Age-adjusted prevalence trends for high blood pressure in Adults age 20 and older by race/ethnicity and sex survey (NHANES: 1988-94, 1999-02 and 2003-06). Source: NCHS and NHLBI. NH- non-Hispanic. Percent of Population 50 40 37.5 38.5 41.4 40.3 41.9 38.2 30.3 30 27.0 25.6 27.8 27.6 26.9 24.8 23.7 25.0 22.9 25.4 26.4 20 10 0 NH White Men NH White Women NH Black Men 1988-94 NH Black Women 1999-02 Mexican American Men 2003-06 Mexican American Women Extent of Awareness, Treatment and Control of High Blood Pressure by Race/Ethnicity and Sex (NHANES: 1999-2006). Source: NCHS and NHLBI. 90 85.3 80 76.9 Percent of Population With Hypertension 71.8 76.6 69.9 70.1 68.1 70 57.7 61.8 59.6 57.9 60 50 41.8 40 43.8 41.9 40.0 34.1 30 31.9 25.6 20 10 0 Awareness Treatment Controlled NH White Men NH White Women NH Black Men NH Black Women Mexican-American Men Mexican-AmericanWomen Trends in mean total serum cholesterol among adolescents ages 12-17 by race, sex, and survey (NHANES: 1976-80, 1988-94, 1999-02, 2003-04, and 2005-06). Mean Total Blood Cholesterol Source: NCHS and NHLBI. 180 175 170 165 160 155 150 145 140 135 172 171 174 170 168 165 166 166 163 163 163 164 163 161161 161 161 160 157 155 156 158 158 151 W hite Males Black Males 1976-80 W hite Black Females Females 1988-94 1999-02 Mex. Am. Males 2003-04 Mex. Am. Females 2005-06 CHD Mortality and Hyperinsulinemia: Paris Prospective Study (n=943) 3 P<0.01 2 CHD mortality (per 1,000) 1 0 29 30-50 51-72 73-114 115 Quintiles (pmol) of fasting plasma insulin Fontbonne AM et al. Diabetes Care. 1991;14:461- Atherosclerosis in Diabetes ~80% of all diabetic mortality 75% from coronary atherosclerosis 25% from cerebral or peripheral vascular disease >75% of all hospitalizations for diabetic complications >50% of patients with newly diagnosed type 2 diabetes have CHD National Diabetes Data Group. Diabetes in America. 2nd ed. NIH;1995. Framingham Heart Study 30-Year Follow-Up: CVD Events in Patients With Diabetes (Ages 35-64) 10 8 Men Women Risk 6 ratio 4 Rate in non-diabetic population *P<0.05 2 0 Total CVD CHD Cardiac failure Intermittent Stroke claudication Age-adjusted annual rate/1,000 P<0.001 for all values Wilson PWF, Kannel WB. In: Hyperglycemia, Diabetes and Vascular Disease. Ruderman N et al, eds. Oxford; 1992.