CMHC Pulse Blog

The Cardiometabolic Challenge: Navigating a Syndemic 

The overlap of the COVID-19 pandemic with persistently rising rates of obesity, diabetes, cardiovascular disease, and other cardiometabolic health conditions has drastically exacerbated the virus death toll. The prevalence of chronic and infectious disease alongside large-scale public health failures have contributed to the adverse outcomes of the unprecedented health crisis, resulting in what The Lancet’s medical journal editor-in-chief, Richard Horton, refers to as a “syndemic.” Defined as the aggregation of two or more concurrent or sequential disease clusters, a syndemic attacks population health on multiple levels of vulnerability, making it extremely difficult to mitigate as evidenced by the current health landscape.

As the past year has shown, the prevailing cardiometabolic disease epidemic within the United States had a profound impact on the population’s COVID-19 mortality rate as well as its ability to control further viral resurgence. Making matters worse, the virus has demonstrated a significant negative impact on obesity, cardiovascular disease, and diabetes presenting a challenge to come in cardiometabolic medicine post-pandemic. What experts have deemed the “impending tsunami of cardiometabolic disease” as part of the COVID-19 aftermath will have worldwide effects expected to last for many years to come and with it, a wave of death and disability of shocking proportion that requires immediate attention and solutions.

Navigating the Syndemic

In the current health environment, the prevention of chronic disease and the management of cardiometabolic conditions are of utmost importance. It is vital to approach the COVID-19 pandemic from a syndemic perspective, one that takes into account the prevalence of chronic disease and health risk factors as well as public health failures that act as barriers to its eradication. Doing so requires targeting the socioeconomic and public health factors that worsen patient prognosis, the efficacy of treatment methods, and the overall population’s outcomes. As the pandemic has highlighted, there is an urgent need to address the health disparities that contribute to the vulnerability of select demographics, especially older and minority citizens who may lack access to healthcare facilities, and other critical resources and have historically experienced extensive barriers and challenges within the healthcare industry.

The cardiometabolic specialty and its dedicated clinicians play a paramount role in the fight against concurrent disease clusters; regulating the cardiometabolic disease epidemic is an invaluable step on the path forward. Although ameliorating the issues at hand requires a multi-level, multi-faceted approach, improving general population health begins with optimizing care delivery strategies, bridging gaps in healthcare access and patient outcomes, as well as developing targeted public health initiatives and interventions.

At this time, comprehensive policy-making is needed to begin the long process of reversing the systemic inequities plaguing the healthcare industry. Following the syndemic approach, which prioritizes an integrated strategy to understanding and treating disease, navigating the current health environment will require the combined efforts of the system and its dedicated clinicians aimed at the state of population health instead of merely attempting to control one epidemic at a time.

Regulating Cardiometabolic Disease

Emerging and existing evidence has shown that cardiometabolic health is critical to reducing the chances of serious illness and the adverse outcomes of COVID-19 as the virus is known to target organs and tissues most relevant to cardiometabolic health. Furthermore, COVID-19-related organ and tissue dysfunction can lead to an increased incidence of cardiometabolic disease, making it essential to regulate these conditions as part of the syndemic response.

Alongside personalized and continuous care delivery, improvements in medication and treatment adherence are necessary. Despite initial patient concerns, medical experts strongly recommend individuals diagnosed with cardiometabolic disease continue to regulate blood pressure and/or glucose levels by taking prescribed treatments. Enhanced patient education and awareness efforts are vital as well due to their ability to strengthen treatment adherence. Additionally, interventions for metabolic conditions such as national and localized weight loss programs can not only improve population cardiometabolic health but also extend benefits to the management of COVID-19.

Further research is needed to better understand how dietary patterns and nutritional status can modify the immune response and how it can help explain variability in morbidity and mortality between COVID-19 patients while ultimately greatly improving patient outcomes.

Strategic Public Health Initiatives

Coordinated efforts are needed to incentivize and encourage to help incentivize and encourage the population to improve health and reduce the risk of serious illness, both in terms of COVID-19 and cardiometabolic diseases. Governmental initiatives can be particularly effective at influencing the health choices of millions of people and raising awareness, as a recent British public health campaign has evidenced. The effort includes several apps and tools that aim to help individuals stay in shape and improve their dietary patterns as well as widespread advertising and social media content. Additional interventions can include food policy amendments and evidence-based public health nutrition campaigns. However, further research is needed to determine the precise role of nutrition in population health and the reduction of the burden of disease both throughout life and across generations.

Navigating the complex environment of a syndemic will require both institutional and individual efforts focused on chronic disease prevention and management, alleviating socioeconomic factors, and mitigating healthcare disparities. Addressing these multifaceted issues will require addressing the epidemic of chronic disease affecting the U.S. population as well as the multitude of risk factors burdening the current state of and endangering future public health. A singular approach will be unsuccessful in the long-term; solving the COVID-19 public health crisis will not be enough. The path forward must view population health holistically as treating one epidemic at a time will allow other disease clusters to fester in the background, temporarily unacknowledged until another health crisis akin to the COVID-19 viral outbreak forces them into the foreground of public attention.

While bracing for the impending tsunami of cardiometabolic disease, clinicians are invited to join other world-renowned experts at the upcoming virtual conference CMHC Spring, The Cardiometabolic Challenge: Navigating a Syndemic taking place between April 16-18, 2021. During this event, distinguished faculty members will present the latest advances in all facets of cardiometabolic health with a special focus on the impact of COVID-19 on the specialty as well as practical strategies for navigating the road ahead.

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