Physician Accreditation
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Medical Education Resources and HealthScience Media, Inc. Medical Education Resources is accredited by the ACCME to provide continuing medical education for physicians.

AAFP – American Academy of Family Physicians
This activity, Cardiometabolic Health Congress 2010, with a beginning date of October 20, 2010, has been reviewed and is acceptable for up to 27.00 Prescribed credits by the American Academy of Family Physicians.

Registered Dietitian Accreditation
This program has been approved by the Commission on Dietetic Registration for 30 CPEUs.

Nursing Accreditation
This activity will offer American Nurses Credentialing Center (ANCC) contact hours for nurses.

Nurse Practitioner Credit Designation
This program is pending approval by the American Academy of Nurse Practitioners.

Pharmacy Accreditation
Medical Education Resources (MER) is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. MER designates this continuing education activity for 30 contact hours (.30 CEUs) of the Accreditation Council for Pharmacy Education.
Universal Program Number: 0816-9999-10-011-L01-P.
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Statement of Need
The prevalence of cardiometabolic risk continues to rise in the United States. American physicians should expect to treat unprecedented numbers of patients at high risk for morbidity and mortality from cardiovascular disease in the years ahead. In 2000, approximately 32% of U.S. adults had the metabolic syndrome, a constellation of cardiometabolic risk factors including excessive abdominal fat, insulin resistance, dyslipidemia, and hypertension.¹ Today, that figure has climbed to nearly 40%.²

Patients with multiple cardiometabolic risk factors have twice the likelihood of developing and dying from cardiovascular disease, and they have more than seven times the risk of developing diabetes.^3-6 As the number of these patients increases, the burden of cardiovascular disease can be expected to increase in the United States as well. Unfortunately, cardiovascular disease already affects 80 million U.S. adults and is the leading cause of U.S. deaths. As a killer, it surpasses cancer (more than 500,000 deaths per year) and accidents (more than 100,000 deaths yearly), causing more than 860,000 deaths each year—an average of 2,400 deaths per day, or one death every 37 seconds, according to the American Heart Association.⁷ The total economic cost of cardiovascular disease for 2009 is estimated at $475 billion.⁷

The Components of Cardiometabolic Risk
Diabetes, another major killer and a leading cardiometabolic risk component, is also on the rise. In just two years, the prevalence of diabetes has increased by 3 million to affect a total of nearly 24 million Americans, or almost 8% of the population, according to the American Diabetes Association and the Centers for Disease Control and Prevention.⁸ By 2050, that figure is expected to rise to 12% of the population. Approximately 1.6 million new cases of diabetes are diagnosed each year. The disease was the seventh leading cause of death in 2006, directly claiming more than 72,000 lives and contributing to about 234,000 additional deaths.⁸ Patients with diabetes are two to four times more likely than those without to die from cardiovascular disease, and diabetes is an important cause of blindness, kidney disease, and lower extremity amputations.⁸ The total economic cost of diabetes in 2007 was $174 billion.⁷ An additional 57 million Americans have prediabetes, a condition that also increases one’s risk for cardiovascular disease.⁸

Diabetes is strongly linked to obesity.⁹ Nearly 50% of people with diabetes are obese, and 90% are overweight.^9,10 Obesity also increases one’s risk for a wide variety of other medical problems, including hypertension, stroke, other forms of cardiovascular disease, arthritis, and several forms of cancer.¹¹ The excess mortality risk associated with obesity is comparable to that of smoking.⁷ The prevalence of obesity and overweight have risen to epidemic proportions in the United States, where two-thirds of adults (142 million individuals) are overweight and, of these, more than half (72 million) are obese.^7,12 The epidemic also affects American children. Approximately 17% of U.S. children and adolescents (9 million) are overweight.¹²

The prevalence of hypertension, another cardiometabolic risk component, is also increasing. In 1994, 24.4% of U.S. adults had hypertension. That figure rose to 29% (more than 70 million individuals) by 2006. During the same time period, the prevalence of pre-hypertension rose from 32% to 37%.^7,13 Hypertension increases one’s risk of suffering a stroke, developing end-stage renal disease, and dying from cardiovascular disease. Hypertension has directly claimed more than 50,000 U.S. lives and contributed to approximately 300,000 additional deaths per year in recent years.⁷ The estimated total economic cost of hypertension for 2009 is $73.4 billion.⁷

Of the components of cardiometabolic risk, only the prevalence of dyslipidemia has declined. The percentage of American adults with high cholesterol has been roughly halved since the 1960s.¹⁴ However, nearly half of U.S adults today (45%) are still at increased risk for atherosclerotic disease because their levels of total cholesterol are elevated (200 mg/dL or higher), according to the American Heart Association.⁷ Of these 98.6 million individuals with elevated cholesterol, 34.4 million still have high cholesterol (240 mg/dL or above), and 71.8 million have LDL-cholesterol levels of 130 mg/dL or higher.⁷ In addition, 16% of otherwise healthy individuals have low levels of HDL-C⁷, and more than half may have elevated triglycerides.¹⁵ Finally, dyslipidemia affects the vast majority (up to 97%) of individuals with diabetes and contributes to their elevated risk for cardiovascular disease.¹⁶

The Comorbidities of Cardiometabolic Risk
Patients with multiple cardiometabolic risk factors face not only the aforementioned health problems, but they also commonly suffer certain comorbidities that can exacerbate cardiovascular risk and severely affect quality of life. These comorbidities include:

• Depression: Growing evidence suggests a link between the metabolic syndrome and depression. Patients with the syndrome tend to score higher than the general population on clinical measures of depression.¹⁷ One recent study found that individuals with the metabolic syndrome had more than double the risk for developing depression compared to those without.¹⁸
• Obstructive sleep apnea: Approximately 50% to 60% of patients with obstructive sleep apnea also have the metabolic syndrome, and evidence of an independent association between the two is accumulating.^19-21
• Polycystic ovary syndrome (PCOS): Women with this syndrome have a five-fold increase in risk for the metabolic syndrome, suggesting that PCOS may be an independent risk factor for cardiometabolic risk.²²
• Hypogonadism, or low testosterone, is associated with increased odds for cardiometabolic risk factors including overweight or obesity, hypertension, and diabetes.²³ Conversely, high testosterone levels have been linked with a more favorable cardiovascular risk profile, and one recent analysis found that men with the highest testosterone levels were 47% less likely to die of cardiovascular disease compared to men with the lowest levels.²⁴
• Erectile dysfunction (ED) is strongly associated with cardiometabolic risk. Men with diabetes are more than twice as likely to have ED, and men with diabetes, hypertension, and hyperlipidemia are more than three times as likely, compared to men without any cardiometabolic risk factors.²⁵ Because symptoms of ED often precede those of cardiovascular disease by several years, clinicians are increasingly recognizing that ED may be a signal of asymptomatic or “silent” cardiovascular disease, and that it is logical to look for cardiometabolic risk factors in patients with ED.²⁶
• Diabetic neuropathic pain affects half of all patients with diabetes.²⁷ Of these, approximately 11%, or more than 1 million patients, suffer chronic pain that diminishes their quality of life, disrupts sleep, and can lead to depression.²⁸
• Chronic kidney disease is most often the result of diabetes or hypertension. Approximately 35% of patients with diabetes develop chronic kidney disease.²⁹ And hypertension causes more than 25,000 new cases of kidney failure in the United States each year.³⁰

Cardiometabolic Risk Factors Are Under-Treated and Difficult to Manage
Despite the well-documented risks of unchecked diabetes, obesity, hypertension, and dyslipidemia, these conditions are commonly under-treated. Even when treated, they remain stubbornly difficult to manage:

1. The majority of treated patients with diabetes fail to meet the minimum A1C goal of 7% or less.³¹ Recent data from the Behavioral Risk Factor Surveillance System found that only 42% of treated patients had an A1C of 7% or less.³² In addition, a report released by the American Association of Clinical Endocrinologists said that two out of three patients with type 2 diabetes were not achieving the association’s recommended A1C goal.³³
2. When it comes to first-line therapy for obesity—diet and exercise—few patients succeed, and any improvements are usually modest.^34,35 Current pharmacotherapy options are limited. Available obesity drugs have to date produced only modest weight loss in most patients and have been linked to adverse gastrointestinal effects and mood disorders.³⁶
3. Only 68% of patients with hypertension are receiving any form of treatment. Of these, only 36% have their blood pressure under control, while hypertension remains uncontrolled in 64% of treated patients.⁷
4. Less than half of those who qualify for any kind of lipid-modifying treatment to reduce the risk of coronary heart disease are receiving it. In fact, less than half of even the highest-risk individuals, those with symptomatic coronary heart disease, are receiving lipid-lowering treatment. Of those being treated, only about one-third are achieving target goals.⁷

Cardiometabolic Risk in Children and Adolescents
Cardiometabolic risk is becoming so common in the United States that it is even affecting our children, suggesting that future generations will bear an even greater burden of cardiovascular disease if adequate treatments cannot be found. More than 9% of U.S. children and adolescents aged 12–19, or nearly 3 million individuals, have the metabolic syndrome, according to estimates from the American Heart Association.³⁷ Among overweight and obese adolescents, the prevalence rate rises to one-third. Two-thirds of adolescents have at least one metabolic abnormality.³⁷

Conclusion
Healthcare professionals play a major role in stemming these health consequences and associated costs by employing aggressive strategies for the early identification and comprehensive management of patients presenting with multiple cardiometabolic risk factors. The 2010 Cardiometabolic Health Congress will translate the latest cutting-edge medical research into practical, clinical approaches for preventing, delaying, and managing cardiovascular and metabolic risk. The goal is to provide the medical community with evidence-based interventions to improve health outcomes and quality of life for the growing numbers of patients at increased cardiometabolic risk.

Learning Objectives
At the end of the Congress, participants will be able to:

• Explain the interrelationships among the various cardiometabolic risk factors, their impact on cardiovascular health, and their common comorbidities.
• Translate evidence-based strategies for prevention, screening, and treatment of cardiometabolic risk factors and their comorbidities to their clinical practice.
• Identify which interventions, including lifestyle changes and various drugs in combination, are most appropriate for particular patients based on their risk profiles.
• Discuss how novel and emerging therapies can best be integrated into clinical practice to reduce morbidity and mortality from cardiovascular disease.

References

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