CardioMetabolic Medicine

CardioMetabolic Risk & The Metabolic Syndrome

Metabolism refers to the sum of the biochemical reactions that occur within in our bodies and these metabolic processes both anabolic, building substances, and catabolic, breaking down substances. Metabolism also refers to the breakdown of food substances and its transformation into energy.

 

CardioMetabolic risk refers to the risk of developing cardiovascular disease (CVD) as it relates to the sum of the CVD Risk Factors that one may exhibit. These risk factors are known to impair cellular metabolism and contribute to the development of the medical conditions that constitute the Metabolic Syndrome and that subsequently increase the risk of cardiovascular disease.

 

Demographically speaking, age and gender are CVD risk factors with males exhibiting higher risk than females, specifically compared to those females of reproductive age. Males 45 years or older are considered high risk with female CVD risk not equaling that of males until they have reached the age of 55 years. Genetic predisposition as assessed via family history of established CVD is also a gender specific. Having a male first degree Relative (father or brother) who was diagnosed with CVD at < 55 years of age and/or having a female first degree relative (mother or sister) who was diagnosed with CVD at < 65 years of age are considered significant risk factors that increase the probability of developing CVD. 

 

Lifestyle choices such as smoking, excess alcohol intake, excess stimulant intake, and recreational drug use are considered risk factors as are activity/exercise and eating behaviors in that sedentary lifestyle and poor nutrition are known to promote the development and progression of cardiovascular disease.

The greater the number CVD risk factors the higher the probability of developing one or more of the conditions/diseases of the Metabolic Syndrome. The Metabolic Syndrome is characterized by a constellation of risk factors that when occurring in a cluster, exponentially increase the incidence of CVD and the probability of sustaining a devastating cardiovascular event such as a Heart attack or stroke.  

 

Consensus regarding the diagnostic criteria for the Metabolic Syndrome continues to be controversial. For practical purposes, we utilize the lowest threshold in each criteria as referenced by the NCEP/ATP III, IDF, WHO, and AACE/ACE Guidelines*. The diagnostic criteria include: 1. Obesity or Central Weight Distribution with a BMI >30 and/or Waist Circumference >102 cm (>40 in) for Males and >88 cm (>35 in) for Females; 2. Insulin Resistance, Prediabetes (Fasting Glucose Between 100-125, or HbA1C >5.7), or Established Type II DM treated with medication; 3. Dyslipidemia, (cholesterol abnormalities) specifically Low HDL Cholesterol: < 40 for Males and <50 for Females and Triglycerides > or equal to 150 in both genders; 4. Elevated Blood Pressure, with Systolic BP > or equal to 130 and Diastolic BP > or equal to 85 or Established Hypertension treated with medication. The Metabolic Syndrome is a clinical entity that is useful to assess risk and to guide treatment for CVD risk reduction and the diagnosis is made when at least 3 of the risk factors are present. We include the additional risk factor of sleep disorders as the prevalence of sleep disorders and the significant contribution to metabolic and CVD risk has paralleled the increased prevalence of overweight and obesity.

The root causes of the metabolic syndrome are considered to be overweight/obesity (specifically central or visceral obesity) associated insulin resistance, and genetic predisposition. Treatment guidelines recommended by the NCEP ATPIII, IDF, WHO, and ACE/AACE* focus on 3 interventions: 1. Aggressive Weight Loss with moderate caloric restriction to Achieve a 5-10% weight reduction within 1 year; 2. Dietary Changes in macronutrient composition consistent for modification of each metabolic condition or CVD risk factor; 3.  Physical Activity/Exercise consistent with the Consensus Public Health Recommendations of at least 30 min of Moderate Intensity Physical Activity on most days of the week; 4. Utilization of Appropriate Pharmacotherapy to treat obesity, prediabetes and diabetes, dyslipidemia, and hypertension.

Physicians who specialize in CardioMetabolic Health identify and reduce cardiovascular risk via a comprehensive evaluation and by implementing treatment with: 1. Lifestyle Modification and 2. Standard of Care Therapy regarding treatment of the medical conditions of the Metabolic Sndrome: 1. Sleep Disorders; 2 Central Weight Distribution, Overweight, and Obesity; 3. Insulin Resistance, PreDiabetes, and Type II Diabetes; 4. Dyslipidemia (Cholesterol Abnormalities); and 5. Hypertension (Elevated Blood Pressure). While simultaneously evaluating and treating the associated or underlying endocrine disorders that disrupt cellular metabolism, contribute to metabolic disease and  CVD risk, and serve as barriers specifically to the primary treatment intervention, Central Weight Reduction. The primary endocrine disorders addressed and treated include: 1. Hypothyroidism; 2. Adrenal Dysfunction; and 3. Male and Female Sex Hormone Disorders. The endocrine treatment goal is the restoration of normal physiologic function for CVD risk reduction utilizing standard of care interventions.

The hallmark of CardioMetabolic Medicine is the comprehensive evaluation and treatment administered via a multi-disciplinary team of experts: physicians, physician assistants, nutritionists, exercise physiologists, physiotherapists, and behavioral medicine practitioners. 

 

Customized disease specific: therapeutic lifestyle changes, dietary intervention, and the exercise prescription, function as the foundation for which all pharmacologic treatment regimens are built upon.

*NCEP ATPIII-(National Cholesterol Expert Panel on Detection, Evaluation, and Treatment of High Cholesterol in Adults, Treatment Panel III, Third Report)

*IDF-(International Diabetes Federation)

*WHO-(World Health Organization)

*AACE/ACE-(American Association of Clinical Endocrinologists, American College of Endocrinology)