Cardiometabolic disorders and weight: Collaborative effort speaks to dire public health issue

Key Points

For the first time, 17 of Advanstar Communications' Life Sciences publications and their Web portal, http://ModernMedicine.com/, are collaborating in a coordinated, interdisciplinary initiative to address a major public health issue: cardiometabolic disorders and weight.

This groundbreaking initiative emphasizes core competencies, best practices, and shared responsibility among all stakeholders in the patient health-care ecosystem. We investigate cardiometabolic disorders and how they interrelate to increase cardiovascular risk significantly. We provide the tools and information that specialists, primary care physicians, midlevel practitioners, nurses, pharmacists, managed care professionals, and the pharmaceutical industry need to work together to address this growing problem and ultimately improve patient outcomes.

From September through November, the project will be featured on Advanstar's ModernMedicine Network, in our 15 health-care publications-Medical Economics, Contemporary OB/GYN, Contemporary Pediatrics, Geriatrics, Formulary, Drug Topics, Managed Healthcare Executive, Ophthalmology Times, Optometry Times, Dermatology Times, Cosmetic Surgery Times, Urology Times, RN, Healthcare Traveler, and Locum Life-and in two of our pharmaceutical publications, Pharmaceutical Executive and Applied Clinical Trials. With 340,000 users on the ModernMedicine Network and a combined print circulation of more than 1 million, these brands provide the news, analysis, and education on which healthcare professionals and executives and pharmaceutical industry leaders alike have come to rely.

The National Heart, Lung, and Blood Institute (NHLBI) estimates that almost 25% of U.S. adults have a constellation of abnormalities constituting what was once called "syndrome X," and later, "metabolic syndrome" or "insulin resistance syndrome."¹ The component disorders include central adiposity defined by waist circumference or hip-waist ratio, elevated triglycerides, low levels of high-density lipoprotein, hypertension, and elevated blood glucose levels. Most people with one cardiometabolic abnormality have others as well, and the cumulative effect is a predisposition to atherosclerotic plaque development, inflammation, and thrombosis, ultimately resulting in cardiovascular disease that is often premature. In fact, the Third Report of the National Cholesterol Education Program–Adult Treatment Panel (ATP III) states that having three or more of these abnormalities confers the same cardiovascular risk as does existing coronary artery disease.² Diabetes alone also carries increased risk similar to that seen among patients with confirmed heart disease.²

The public health impact of cardiometabolic abnormalities becomes clearer when one considers that 38.9% of U.S. adults report a prescription drug expense for a cardiovascular agent and 28.9 % report a prescription drug expense for a metabolic agent. Furthermore, metabolic agents are the number 1 type of medication prescribed in the United States, accounting for an expenditure of $38.1 billion annually, and cardiovascular agents rank number 2 at $33.1 billion annually.³

Developing effective management strategies for patients with a cluster of cardiometabolic abnormalities has been confounded by the differing definitions of, and treatment guidelines for, metabolic syndrome issued by various government entities and organizations. The NHLBI and the American Heart Association collaborate to update the ATP metabolic syndrome criteria and treatment guidelines.⁴ The World Health Organization and the International Diabetes Federation also recognize metabolic syndrome, but their criteria differ from each other and also from ATP III; The European Group for the Study of Insulin Resistance has yet another set of criteria (see Table).^5–7

A further complication for healthcare professionals seeking to identify the most appropriate treatment strategies from current guidelines is that the American Diabetes Association (ADA) and the European Association for the Study of Diabetes do not recognize metabolic syndrome per se. Instead, they recommend that any patient with one cardiometabolic disorder be screened for the others and that each component disorder be treated to its individual target.⁸ In addition, current guidelines from the NHLBI-sponsored Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7) recommend a lower blood pressure goal for patients with diabetes than does ATP III,⁹ and current ADA treatment guidelines recommend earlier drug treatment-at the prediabetes level-especially for patients with other risk factors for developing type 2 diabetes, including hypertension, low high-density lipoprotein levels, elevated triglycerides, and obesity.¹⁰

Not only do the various treatment parameters conflict, they are updated often. For example, the NHLBI has convened experts to update both ATP and JNC guidelines, and the proposed new versions are expected to be available for public comment in December. The ADA released its updated clinical practice guidelines earlier this year.¹⁰

Our cross-therapeutic approach to addressing this issue provides specific knowledge and practical strategies to improve the treatment of patients with these conditions. This overview describes how cardiometabolic disorders and weight intersects with each therapeutic area/practice setting and outlines the related coverage by brand.