Cardiometabolic disorders are the major cause of mortality worldwide, and are linked to endocrine disorders such as diabetes and thyroid dysfunction. In patients with type 2 diabetes (T2DM), cardiovascular disease typically develops 14 years earlier, is more severe, and the risk of death due to cardiovascular causes is more than doubled, compared with individuals without diabetes. Pre-diabetes is associated with early metabolic decompensation (hypertension, obesity, and dyslipidemia) and early endothelial dysfunction, predisposing to cardiova- scular events. Reversal of the key pathogenic pathways of diabetes and metabolic syndrome, (insulin resistance and relative insulin deficiency) is therefore crucial to halt the path towards a cardiometabolic pandemic.
Thyroid disorders account for several pathological conditions with high prevalence worldwide. Since thyroid hormones have a role in regulating a number of metabolic pathways, as well as cardiac function, even small alterations in thyroid function causes impairment. Indeed, both subclinical hypo- and hyper-thyroidism adversely affect the cardiovascular system, and are associated with obesity, insulin resistance, hypertension, heart failure, and lipid disorders. Recognition and treatment of thyroid dysfunction is therefore crucial, especially during pregnancy, in the frail elderly, and in subjects with associated cardiometabolic conditions, such as hypertension.
Hypertension is a major cardiovascular risk factor and a leading cause of death in its own right. The prevalence of hypertension is set to increase worldwide despite global efforts to reduce it. The 2018 ESH/ESC Hypertension Guidelines have promoted ambitious targets for blood pressure control, thereby supporting more aggressive treatments. Another new and important aspect of these Guidelines is the primary role for combination therapy with fixed-dose medications. This change will affect daily clinical practice, and thus, the scientific evidence supporting these recommendations deserves highlighting and discussion. This program will also focus on the role of increased sympathetic activity in the pathogenesis of hypertension-related increases in cardiovascular risk and the need to consider high heart rate as a target for treatment.
