The term ‘cardiometabolic’ has recently crept into the medical literature as a designation for the common constellation of risk factors that promote atherogenic cardiovascular disease and/or the development of type 2 diabetes.
A position paper by the Canadian Cardiometabolic Risk Working Group, under the leadership of Lawrence Leiter (Toronto), just published in the Canadian Journal of Cardiology, addresses the concepts of ‘cardiometabolic risk’, ‘metabolic syndrome’, and ‘risk stratification’, what these terms mean, and how they can best be used to improve our understanding of cardiovascular disease treatment and prevention.
The authors propose ‘global cardiometabolic risk’ as an umbrella term for a comprehensive list of existing and emerging factors (including abdominal obesity) that predict cardiovascular disease and/or type 2 diabetes.
The paper presents practical strategies to identify and reduce cardiometabolic risk in multiethnic patient populations, based on an extensive review of data on emerging cardiovascular risk factors and Canadian guideline recommendations.
Health behaviour interventions (weight loss, physical activity, diet, smoking cessation) and pharmacotherapy in appropriate patients are essential to reduce cardiometabolic risk and are best delivered by a multidisciplinary approach.
In the context of obesity, readers will recall that, while important, ‘cardiometabolic’ risk touches on only one of the four ‘Ms’ (metabolic) relevant to the assessment and management of individuals with excess weight - the other three ‘Ms’ (mental, mechanical, and monetary health), all of which can affect patients even in the absence of metabolic problems, may be as important for the quality-of-life, functioning and overall health of overweight and obese individuals.
Perhaps similar working groups will now be convened to address the global ‘mental’, ‘mechanical’ and ‘monetary’ (=socioeconomic) risk factors associated with excess weight.
Indeed, it may well be that in overweight and obese patients with significant ‘mental’, ‘mechanical’ and/or ‘monetary’ health problems, simply focussing all efforts on improving ‘metabolic’ health may prove daunting if not futile.
AMS
Edmonton, Alberta
Cardiometabolic Risk Working Group: Executive Committee, Leiter LA, Fitchett DH, Gilbert RE, Gupta M, Mancini GB, McFarlane PA, Ross R, Teoh H, Verma S, Anand S, Camelon K, Chow CM, Cox JL, Després JP, Genest J, Harris SB, Lau DC, Lewanczuk R, Liu PP, Lonn EM, McPherson R, Poirier P, Qaadri S, Rabasa-Lhoret R, Rabkin SW, Sharma AM, Steele AW, Stone JA, Tardif JC, Tobe S, & Ur E (2011). Cardiometabolic risk in Canada: a detailed analysis and position paper by the cardiometabolic risk working group. The Canadian journal of cardiology, 27 (2) PMID: 21459257
In The News
April 6th, 2011 at 10:25 am
Health behaviour interventions (weight loss, physical activity, diet, smoking cessation)
Hope this isn’t too pedantic, but physical activity, diet, and smoking cessation are behaviors. How is weight loss a behavior? (maybe if it was done by DIY liposuction
April 6th, 2011 at 10:32 am
I can think of some very commonly prescribed medications that are being linked with elevated blood sugar, weight gain or athrogenic cardiovascular disease. Maybe it’s time to look at the prescriptions patients are currently taking before adding more medications to their list. When I was a student nurse 35 years ago, the goal was 5 medications or less for the geriatric patients because of all the possible interaction variables. Sometimes less is a better option than more when it comes to pharmaceuticals.
April 6th, 2011 at 11:42 am
I think your last point is very true for many people. I’ve come to the conviction that for me the mental element has to be improved before weight loss and diet can be successfully addressed. I’ve only recently begun to think at all about the socioeconomic aspect. I suspect its a much bigger problem than I realized. I’m not sure what the ‘mechanical’ (mobility/access issues?)would be so I can’t comment on that.
In beginning to think about obesity in a holistic way, medicine may be finally getting toward some treatment breakthroughs.