Cardiometabolic disease is a major cause of morbidity and mortality worldwide. In the very near future, 75% of patients with this condition will be living in developing countries, and will have acquired cardiometabolic disease as a consequence of their changing lifestyle, particularly the rapid increase in the prevalence of obesity and the reduction in their activity levels.
Metabolic pathways regulated by the endocrine system play key roles in the maintenance of cardiometabolic health in terms of blood glucose regulation, lipid profile and blood pressure control. Hyperglycaemia is one of the major modifiable cardiovascular risk factors, with >700 million people affected by pre-diabetes or overt diabetes worldwide. Vascular physiology and glucose metabolism are inherently interwoven, and suboptimal operation of either is one of the first steps towards a patient developing cardiometabolic disorder. This highlights the relevance of diagnosing and treating pre-diabetes, in order to reverse progression to diabetes and cardiovascular disorders.
The cardiovascular system is very sensitive to changes in circulating thyroid hormone levels. Subclinical hypothyroidism is seen in up to 15% of the adult population and is associated with adverse clinical outcomes, particularly cardiovascular disease. The most recent clinical trial results have shown that treating subclinical hypothyroidism has a positive impact on vascular health and consequently on cardiovascular outcomes.
A further major component of cardiometabolic disease is hypertension, itself a leading cause of death directly related to both insulin resistance and thyroid dysfunction. To try and combat the mortality rates associated with hypertension, the 2018 ESH/ESC Hypertension Guidelines proposed more ambitious targets for blood pressure control and supported implementing a pathophysiology-based treatment approach – namely, treating the increase in sympathetic activity, which is one of the most important pathways leading to both essential hypertension and insulin resistance. There are synergies between diabetes and hypertension which results in a worse prognosis if the two pathologies coexist. Although a large body of evidence supports the efficacy of combined lifestyle changes and effective drug treatment, this approach to cardiovascular disease is far from effective, as fewer than 50% of patients reach the therapeutic target for each risk factor.
The incidence of cardiometabolic disease is set to increase and to affect all areas of the world. This regional symposium is designed to highlight both the general problems of this condition, but also the specific problems cardiometabolic disease is bringing to the Europe, the Middle East and Africa. Results from clinical trials, best practice from International Guidelines and clinical experience from local experts will provide up-to-date and relevant information to help healthcare professionals help patients with this increasingly prevalent and life-limiting condition.
