PracticeUpdate: Could you give an insight into the spectrum of cardiometabolic diseases?
Dr. Fialkow: Cardiometabolic disease or the cardiometabolic syndrome is a term we use for a confluence of medical conditions, which we've known about for decades, and we've known they produce cardiac problems, but we now recognize they're all due to a singular underlying metabolic abnormality, that of insulin resistance and impaired glucose tolerance.
These disease states are things like hypertension, lipid abnormalities, diabetes. The reason they're important is because they all lead towards heart attacks and renal insufficiency, kidney failure. Now we're looking at the underlying metabolic disturbances that manifest as these disease conditions that cause the ultimate bad problems, which is heart disease and renal insufficiency.
PracticeUpdate: What steps can people with diabetes take to lower their risk of a cardiac event?
Dr. Fialkow: Diabetes is a hallmark of the cardiometabolic syndrome, even the pre-diabetic, the insulin-resistant. The reason is we tended to used to think that, diabetes, as a disorder of sugar metabolism and glucose metabolism, all these cardiac and renal events were due to the sugar level. Now we know the underlying metabolic disturbances regarding hypertension and lipid abnormalities can even precede the sugar going up. As a result, while we do recommend common steps that continue to work towards avoiding cardiovascular conditions and renal insufficiency, things like exercising regularly, having proper nutrition, and we can discuss that. What that means, generally not overeating at all, keeping your weight down, and certainly avoiding refined and processed starches and sugars, quitting smoking, which can cause cardiovascular disease. We know that by regulating underlying metabolic disturbances and applying resources to mitigate them and treat them can decrease the heart attack, the stroke, the renal insufficiency. What that means is the diabetic is at risk for heart attack and stroke and kidney failure, but it's not necessarily through the sugar. It's through other components of the medical problems.
PracticeUpdate: How have the recent advances in management of cardiometabolic risk factors helped mitigate these events?
Dr. Fialkow: Why this is kind of interesting and exciting is we now have weapons available towards decreasing the risk of heart attacks, strokes, hospitalizations for heart failure and renal insufficiency for these patients that we didn't have before. Clearly, nutrition, exercise, and not smoking are critical, but there's new families of medications, which were originally looked at to lower sugar, which we found did not necessarily lower the sugar that well, but have profound cardiovascular benefits. These medications and this family of medications are probably the most significant advancements in treating the cardiometabolic syndrome, and again, not to make numbers better, but to decrease heart attack, stroke, and kidney failure.
Many of the recent advancements managing cardiometabolic risk factors start with the identification of who's at risk. We now have a better understanding what these metabolic disturbances are, so we can identify patients who are developing these metabolic disturbances and not wait for them to get far along in their disease course, when they've already had significant heart disease or kidney abnormalities, renal dysfunction.
When we identify who these patients are, it could be with blood tests, it could be with just knowing how people are gaining weight more in the belly than anywhere otherwise, then we can apply these resources to them more. Clearly, we want them to exercise. Clearly, we want them to follow a proper diet and keep their weight down. What that looks like can be somewhat controversial, and, quite frankly, probably different for different people. But we do have these weapons available to us that we didn't have before.
Most prominent are lipid medications, medications to modify the cholesterol, triglycerides, the lipids in the body that can lead to vascular disease, but also two families of medications, SGLT2 inhibitors and GLP1 receptor agonists, which are two families of medications, which have actually been around for a while.
They were originally developed for mild improvements in one's blood sugar, but now we're finding profound benefits towards actually preventing heart attack, strokes, and essentially renal disease.