Key result
New cardiometabolic model highlights primary and metabolic drivers to expose actionable CVD prevention targets.
Why the study?
A new cardiometabolic-based chronic disease model was developed to provide a basis for early therapeutic targeting to promote cardiometabolic health and expose actionable targets for cardiovascular disease prevention.
Proposes a cardiometabolic-based chronic disease model to identify actionable targets for early prevention of cardiovascular disease.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“The role of healthy lifestyles and pharmacotherapy targeting metabolic drivers to reduce cardiovascular risk is well established. However, lessons learned from the COVID-19 pandemic support shorter-term benefits of these interventions, similar to observed benefits on acute cardiovascular disease outcomes.”
“It seems that those four factors really do intersect and interact across COVID-19 … to cause worse outcomes.”
“Rather than stipulating that primary targets are mutually exclusive—weight or glucose—we should think about weight loss and glucose as part of a comprehensive care plan that addresses multiple chronic disease drivers. Indeed, there are multiple primary targets—adiposity, dysglycemia, and other cardiometabolic risk factors—that can be prioritized based on relative risks, logistical ease, cost, and individual factors. Primary targets can be addressed concurrently, not necessarily sequentially.”
May prompt targeting of metabolic drivers for CVD prevention; leaves open validation via prospective trials before practice adoption.
A new cardiometabolic-based chronic disease (CMBCD) model is presented that provides a basis for early and sustainable, evidence-based therapeutic targeting to promote cardiometabolic health and mitigate the development and ravages of cardiovascular disease. In the first part of this JACC State-of-the-Art Review, a framework is presented for CMBCD, focusing on 3 primary drivers (genetics, environment, and behavior) and 2 metabolic drivers (adiposity and dysglycemia) with applications to 3 cardiovascular endpoints (coronary heart disease, heart failure, and atrial fibrillation). Specific mechanistic pathways are presented configuring early primary drivers with subsequent adiposity, insulin resistance, β-cell dysfunction, and metabolic syndrome, leading to cardiovascular disease. The context for building this CMBCD model is to expose actionable targets for prevention to achieve optimal cardiovascular outcomes. The tactical implementation of this CMBCD model is the subject of second part of this JACC State-of-the-Art Review.
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Mechanick et al. (2020) conducted a review in Cardiometabolic-based chronic disease. Cardiometabolic-based chronic disease (CMBCD) model was evaluated. A new cardiometabolic-based chronic disease model is presented, focusing on primary and metabolic drivers to expose actionable targets for cardiovascular disease prevention.
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