Poll: A Call for a New Cardiometabolic Subspecialty

The cardiometabolic conditions including obesity, metabolic syndrome, and diabetes mellitus (DM) are all strongly associated with increased risk of cardiovascular disease (CVD) and mortality, causing enormous health and economic burden.

In the United States (US), the prevalence of DM has increased significantly in recent decades, with a concomitant rise in the burden of obesity. The estimated number of US adults with diabetes for 2018 was ~34 million.1 The total estimated costs of diagnosed diabetes increased from $261 billion in 2012 to $327 billion in 2017.1 By the year 2060, the number of US adults with diagnosed diabetes is projected to increase nearly threefold.2 The adverse trends in obesity, diabetes, and other cardiometabolic disorders continue to increase both in the US and throughout the world.

In the current healthcare delivery system, key providers involved in the management of diabetes and other metabolic disorders include endocrinologists and primary care specialists. However, high-risk patients with DM and CVD are more likely to follow up with a cardiologist than with an endocrinologist.3 Moreover, the implementation of effective and emerging preventive and therapeutic strategies to care for patients with cardiometabolic conditions may be inadequate. For example, despite demonstrated CV benefits with sodium glucose co-transporter-2 inhibitors and glucagon-like peptide-1 receptor agonists in DM patients, their use remains limited.4-6 With an aging population, increase in physical inactivity, obesity, stress, the number of adults living with cardiometabolic conditions continues to increase with a substantial impact on the quality of life, frequent hospitalizations, and premature death.

Given the increasing complexity of managing patients with cardiometabolic conditions, there is an urgent need to address the gaps in the current healthcare structure in providing optimal care for these patients. In 2019, Drs. Eckel and Blaha proposed a 3-year fellowship training in cardiometabolic medicine including components of internal medicine, cardiology, and endocrinology, with a focus on providing care for DM, obesity and primary and secondary prevention of atherosclerotic cardiovascular disease (ASCVD).7 More recently, McCarthy and colleagues put forth a framework for a more compact 1-year cardiometabolic post-fellowship program after subspecialty training in general cardiology, endocrinology, or nephrology to effectively care for patients with cardiometabolic disease.8

Overall, an intensely concentrated approach to prevent and manage cardiometabolic conditions through early assessment and targeted therapy may be the much-needed shift in the current healthcare framework to curb the ongoing epidemic and adverse cardiovascular complications.

References

  1. Centers for Disease Control and Prevention. National Diabetes Statistics Report: Estimates of Diabetes and its Burden in the United States. (US Department of Health and Human Services website). 2020. Available at: https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf. Accessed 03/25/20. 
  2. Lin J, Thompson TJ, Cheng YJ, et al. Projection of the future diabetes burden in the United States through 2060. Popul Health Metr 2018;16:9.
  3. Gunawan F, Partridge C, Kosiborod M, Inzucchi S. SUN-149 cardiologist vs. endocrinologist encounters in patients with T2D and CVD: potential implications for glucose-lowering therapy use and education. J Endocr Soc 2019;3.
  4. Cosentino F, Grant PJ, Aboyans V, et al. 2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. Eur Heart J 2020;41:255-323.
  5. American Diabetes Association. 9. Pharmacologic approaches to glycemic treatment: standards of medical care in diabetes-2020. Diabetes Care 2020;43:S98-S110.
  6. Arnold SV., Inzucchi SE, Tang F, et al. Real-world use and modeled impact of glucose-lowering therapies evaluated in recent cardiovascular outcomes trials: an NCDR® Research to Practice project. Eur J Prev Cardiol 2017;24:1637-45.
  7. Eckel RH, Blaha MJ. Cardiometabolic medicine: a call for a new subspeciality training track in internal medicine. Am J Med 2019;132:788-90.
  8. McCarthy CP, Chang LS, Vaduganathan M. Training the next generation of cardiometabolic specialists. J Am Coll Cardiol 2020;75:1233-7.

Clinical Topics: Acute Coronary Syndromes, Diabetes and Cardiometabolic Disease, Dyslipidemia, Prevention, Vascular Medicine

Keywords: Diabetes Mellitus, Acute Coronary Syndrome, Metabolic Syndrome X, Dyslipidemias, Primary Prevention, Secondary Prevention, Vascular Diseases, Aneurysm, Cardiovascular Diseases, Mortality, Premature, Nephrology, Quality of Life, Specialization, Follow-Up Studies


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