Cardiometabolic-Based Chronic Disease, Adiposity and Dysglycemia Drivers

Highlights

• The cardiometabolic-based chronic disease model is designed to optimize early and sustainable preventive care.

• Genetics, environment, and behavior are primary drivers, and adiposity and dysglycemia are metabolic drivers of cardiometabolic-based chronic disease.

• Cardiometabolic endpoints include coronary heart disease, heart failure, and atrial fibrillation.

• A detailed prevention plan can be fashioned based on this model.

Abstract

A new cardiometabolic-based chronic disease (CMBCD) model is presented that provides a basis for early and sustainable, evidence-based therapeutic targeting to promote cardiometabolic health and mitigate the development and ravages of cardiovascular disease. In the first part of this JACC State-of-the-Art Review, a framework is presented for CMBCD, focusing on 3 primary drivers (genetics, environment, and behavior) and 2 metabolic drivers (adiposity and dysglycemia) with applications to 3 cardiovascular endpoints (coronary heart disease, heart failure, and atrial fibrillation). Specific mechanistic pathways are presented configuring early primary drivers with subsequent adiposity, insulin resistance, β-cell dysfunction, and metabolic syndrome, leading to cardiovascular disease. The context for building this CMBCD model is to expose actionable targets for prevention to achieve optimal cardiovascular outcomes. The tactical implementation of this CMBCD model is the subject of second part of this JACC State-of-the-Art Review.