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Cardiometabolic risk management: insights from a European Society of Cardiology Cardiovascular Round Table
Francesco Cosentino1, Subodh Verma2, Philip Ambery3
1Cardiology Unit, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Solna, 171 76 Stockholm, Sweden.
Insights
Metabolic conditions like Type 2 diabetes and obesity significantly impact cardiorenal disease, increasing risks and complicating management. Integrated strategies targeting shared pathways are crucial for improving patient outcomes.
Area of Science:
- Cardiology
- Nephrology
- Hepatology
- Endocrinology
- Metabolic Diseases
Background:
- Metabolic comorbidities such as Type 2 diabetes mellitus (T2DM), obesity, chronic kidney disease (CKD), and chronic liver disease are prevalent in patients with cardiorenal disease.
- These conditions share common risk factors like dyslipidemia and hypertension, leading to overlapping pathophysiological pathways that damage cardiovascular, renal, and hepatic systems.
- The COVID-19 pandemic has exacerbated the complexity of managing cardiometabolic diseases, increasing risks for individuals with these comorbidities and potentially worsening pre-existing cardiovascular conditions.
Purpose of the Study:
- To highlight the intricate relationship between metabolic comorbidities and cardiorenal disease.
- To emphasize the need for improved recognition and integrated treatment of atherosclerotic cardiovascular disease (ASCVD) in patients with metabolic disorders and vice versa.
- To review current and emerging strategies for the prevention and management of cardiometabolic diseases.
Main Methods:
- Review of existing literature on the interplay between metabolic diseases and cardiorenal conditions.
- Analysis of shared risk factors and pathophysiological mechanisms.
- Evaluation of current and novel therapeutic strategies, including lifestyle modifications, pharmacotherapies, and weight loss interventions.
Main Results:
- Metabolic comorbidities significantly contribute to the development, progression, and poor prognosis of cardiorenal disease and ASCVD.
- Shared metabolic and functional abnormalities drive multi-organ damage through interconnected pathways.
- Emerging pharmacotherapies (e.g., SGLT2 inhibitors, GLP-1 RAs) and weight loss strategies show promise in managing these complex conditions.
Conclusions:
- Integrated management strategies are essential for addressing the high burden of metabolic comorbidities in cardiorenal disease.
- Pharmacotherapies targeting specific metabolic pathways and weight management interventions offer effective approaches.
- Further research into novel biomarkers is needed for early risk identification and development of new treatments.
Abstract:
Metabolic comorbidities are common in patients with cardiorenal disease; they can cause atherosclerotic cardiovascular disease (ASCVD), speed progression, and adversely affect prognosis. Common comorbidities are Type 2 diabetes mellitus (T2DM), obesity/overweight, chronic kidney disease (CKD), and chronic liver disease. The cardiovascular system, kidneys, and liver are linked to many of the same risk factors (e.g. dyslipidaemia, hypertension, tobacco use, diabetes, and central/truncal obesity), and shared metabolic and functional abnormalities lead to damage throughout these organs via overlapping pathophysiological pathways. The COVID-19 pandemic has further complicated the management of cardiometabolic diseases. Obesity, T2DM, CKD, and liver disease are associated with increased risk of poor outcomes of COVID-19 infection, and conversely, COVID-19 can lead to worsening of pre-existing ASCVD. The high rates of these comorbidities highlight the need to improve recognition and treatment of ASCVD in patients with obesity, insulin resistance or T2DM, chronic liver diseases, and CKD and equally, to improve recognition and treatment of these diseases in patients with ASCVD. Strategies to prevent and manage cardiometabolic diseases include lifestyle modification, pharmacotherapy, and surgery. There is a need for more programmes at the societal level to encourage a healthy diet and physical activity. Many pharmacotherapies offer mechanism-based approaches that can target multiple pathophysiological pathways across diseases. These include sodium-glucose cotransporter-2 inhibitors, glucagon-like peptide-1 receptor agonists, selective mineralocorticoid receptor antagonists, and combined glucose-dependent insulinotropic peptide/glucagon-like peptide-1 receptor agonist. Non-surgical and surgical weight loss strategies can improve cardiometabolic disorders in individuals living with obesity. New biomarkers under investigation may help in the early identification of individuals at risk and reveal new treatment targets.
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