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The global cardiovascular-liver-metabolic syndemic: epidemiology, trends and challenges

Nicholas W S Chew1,2, Anurag Mehta3, Rachel Goh4

  • 1Department of Cardiology, National University Heart Centre, National University Health System, Singapore, Singapore. nicholas_ws_chew@nuhs.edu.sg.

Nature Reviews. Cardiology
|October 6, 2025
PubMed

Insights

Cardiovascular-liver-metabolic diseases, including fatty liver disease, diabetes, and obesity, form a syndemic. A new framework proposes multisystem interventions to address these interconnected public health challenges.

Area of Science:

  • Public Health
  • Epidemiology
  • Metabolic Diseases

Background:

  • Metabolic-dysfunction-associated steatotic liver disease (MASLD), type 2 diabetes mellitus (T2DM), obesity, and cardiovascular disease (CVD) are escalating global epidemics.
  • These conditions often coexist, forming a cardiovascular-liver-metabolic (CLM) syndemic with shared underlying mechanisms and socioeconomic drivers.

Purpose of the Study:

  • To establish a unified framework for understanding and addressing the CLM syndemic.
  • To present epidemiological data on the current burden and future trends of CLM diseases.
  • To discuss challenges and propose integrated solutions for CLM health promotion.

Main Methods:

  • Review of epidemiological data to illustrate disease burden and trends.
  • Development of a micro-meso-macro framework for CLM health interventions.
  • Analysis of socioeconomic influences and competing risks within the CLM construct.

Main Results:

  • The CLM syndemic presents a significant and growing public health challenge.
  • A proposed micro-meso-macro framework integrates strategies from individual risk prediction to macro-level social determinants.
  • Multisystem interventions are necessary to simultaneously address the interconnected CLM disease epidemics.

Conclusions:

  • Addressing the CLM syndemic requires a comprehensive, multi-level approach.
  • Integrating precision prevention, community-based health promotion, and systemic interventions is crucial.
  • Tackling inequities in social and commercial determinants of health is essential for effective CLM disease control.

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