Cardiometabolic Chronicle

A Cardiometabolic Subspecialty? Not Such A Crazy Idea

The global epidemic of metabolic syndrome, a constellation of cardiometabolic risk factors, and that of obesity, type 2 diabetes, atherosclerosis, and cardiovascular disease (CVD) have become the modern-day health hazard across the world. In the US, the numbers are particularly striking. Even with the recent reports that the incidence of diabetes fell by 35% in the last 20 years1 , there are more than 30 million US adults living with diabetes, 1.5 million Americans are diagnosed with diabetes every year, and 84 million have prediabetes.2 The increasing prevalence of obesity (now estimated to affect more than 93 million, or nearly 40% of all US adults), high cholesterol (95 million US adults have cholesterol levels of >200 mg/ dL), and hypertension (46% of US adults using the new guidelines), together with type 2 diabetes (T2D) are some of the major drivers in cardiovascular morbidity and mortality, and altogether causing billions if not trillions of dollars to the US economy.3-5

At Cardiometabolic Health Congress, we have been at the forefront of looking at the whole spectrum of cardiometabolic disease, including obesity, diabetes, lipids, hypertension, cardiovascular disease, and practical ways to address them. We strive to synthesize and translate the latest developments across the different fields to promote evidence-based strategies to tackle this growing epidemic. As these diseases or risk factors exist in a continuum, they can’t be addressed individually or in a vacuum, which is unfortunately what tends to happen in clinical practice. As CMHC Chair Robert H. Eckel, MD and Michael J. Blaha, MD, MPH describe in a powerful editorial published in The American Journal of Medicine, “patients are shunted back and forth among cardiologists, endocrinologists, and primary care physicians—with uncertain “ownership” of different aspects of the patient’s care.” As such, meaningful change in patients outcomes continue to elude us, as the statistics above show

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REFERENCES:
  1. Benoit, Stephen R., et al. “New directions in incidence and prevalence of diagnosed diabetes in the USA.” BMJ Open Diabetes Research and Care 7.1 (2019): e000657.
  2. American Diabetes Association. “Statistics about diabetes.” Available at http://www.diabetes.org/diabetes-basics/statistics/, accessed August 6, 2019.
  3. Centers for Disease Control and Prevention. “Adult obesity facts.” Available at https://www.cdc.gov/obesity/data/adult.html, accessed August 6, 2019.
  4. Centers for Disease Control and Prevention. “High cholesterol facts.” Available at https://www.cdc.gov/cholesterol/facts.htm, accessed August 6, 2019.
  5. Benjamin, Emelia J., Paul Muntner, and Márcio Sommer Bittencourt. “Heart disease and stroke statistics-2019 update: a report from the American Heart Association.” Circulation 139.10 (2019): e56-e528.
  6. Eckel, Robert H., and Michael J. Blaha. “Cardiometabolic Medicine: A Call for a New Subspeciality Training Track in Internal Medicine.” The American Journal of Medicine (2019).
  7. Carbone, Salvatore, et al. “Glucose-lowering therapies for cardiovascular risk reduction in type 2 diabetes mellitus: State-of-the-Art Review.” Mayo Clinic Proceedings 93.18 (2018): 1629 – 1647.
  8. Das, Sandeep R., et al. “2018 ACC expert consensus decision pathway on novel therapies for cardiovascular risk reduction in patients with type 2 diabetes and atherosclerotic cardiovascular disease: a report of the American College of Cardiology Task Force on Expert Consensus Decision Pathways.” Journal of the American College of Cardiology 72.24 (2018): 3200-3223.
  9. Gerstein, Hertzel C., et al. “Dulaglutide and cardiovascular outcomes in type 2 diabetes (REWIND): a double-blind, randomised placebo-controlled trial.” The Lancet (2019).
  10. Sunder, M. D. “Heart Failure with Preserved Ejection Fraction: A Review of the ACC/AHA Guidelines and Evidence-Based Management Strategy.” The Medicine Forum 20.1 (2019).
  11. Packer, Milton. “Why it’s still 1989 for primary care.” Medpage Today. July 03, 2019, available at https://www.medpagetoday.com/blogs/revolutionandrevelation/80822, accessed August 7, 2019.
  12. Arnold, Suzanne V., et al. “Use of Guideline-Recommended Risk-Reduction Strategies Among Patients with Diabetes and Atherosclerotic Cardiovascular Disease: Insights from Getting to an Improved Understanding of Low-Density Lipoprotein Cholesterol and Dyslipidemia Management (GOULD).” Circulation (2019).
  13. Vardeny, Orly, and Muthiah Vaduganathan. “Practical Guide to Prescribing Sodium-Glucose Cotransporter 2 Inhibitors for Cardiologists.” JACC: Heart Failure 7.2 (2019): 169-172.
  14. Young, Randy. “Cardiology & diabetes: collaborating to defeat a dangerous duo.” CardiovascularBusiness, available at https://www.cardiovascularbusiness.com/topics/lipids-metabolic/ cardiology-diabetes-collaborating-defeat-dangerous-duo, accessed August 9, 2019.
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