Prevention or reversal of cardiometabolic diseases

Abstract

Cardiometabolic risk is a condition in which the possibilities of developing vascular diseases including hypertension, metabolic syndrome, obesity, type 2 diabetes, ischemic heart disease, and stroke are significantly enhanced as a consequence of the presence of various risk factors, which are known to promote these conditions. Cardiovascular diseases (CVDs) cause one-third of all deaths worldwide. Noncommunicable Disease Risk Factor Collaboration, in their seminal article in the Lancet (April 2016), concluded that “if the post-2000 trends continue in the incidence and rise of diabetes, the probability of meeting the global target of halting the rise in the prevalence of diabetes by 2025–2020 level worldwide is lower than one percent.“ According to the Institute for Health Metrics and Evaluation, today, 2.1 billion people, nearly 30% of the global population, are either obese or overweight – a new, first-of-a-kind analysis of trend data from 180 countries. As part of the 2020 impact goals, the American Heart Association (AHA) has set out seven ideal health goals; not smoking, maintaining a normal weight, increased physical activity, a healthy diet, normal blood lipid levels, normal blood pressure, and a normal fasting glucose. An analysis of the National Health and Nutritional Examination Survey showed that individuals who met five of the seven ideal metrics of AHA had a 78% reduction in the hazard ratio for all-cause mortality. The INTERHEART study estimated that modifiable risk factors accounted for 90% of the population attributable risk for heart disease in men and 94% of the risk in women. Consistent with this, Khera et al. (NEJM: 375:2349–582,016) showed that in four studies with over 55,000 participants, a favorable lifestyle intervention was associated with nearly 50% lower risk for coronary artery disease, in spite of the genetic risk. In this overview, we discuss some prevention strategies for the major cardiometabolic conditions such as hypertension, obesity, type 2 diabetes, and ischemic heart disease. We also discuss results of studies in which reversal of these disease conditions has been claimed.