ACC Corner | Cardio-Metabolic Syndrome: Insights & Opportunities Abound

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 - William J. Oetgen, MD, MBA, FACC
William J. Oetgen, MD, MBA, FACC

Metabolic syndrome is the concurrence in an individual of multiple metabolic abnormalities associated with cardiovascular disease. Research has shown a link to the risk of cardiovascular events and mortality. With the prevalence of metabolic syndrome increasing, the cardiovascular field has been challenged with educational and research opportunities to build awareness and learn more about this growing health problem.

The occurrence of metabolic syndrome is difficult to measure, partially based on differing definitions of the disease. The American Heart Association estimates that up to 35 percent of all U.S. adults have metabolic syndrome. The incidence in children is increasing, and the fear is that the consequent increase in cardiovascular events will soon be discernible in population health statistics.

Several recent publications have emphasized the importance of the cardio-metabolic syndrome for practicing cardiologists. Scott M. Grundy, MD, PhD, of the University of Texas Southwestern at Dallas, provided a comprehensive review of the concept of prediabetes, the metabolic syndrome and the assessment of cardiovascular risk (J Am Coll Cardiol 2012;59:635-643). He concluded that prediabetes, as defined by the presence of either impaired fasting glucose or impaired glucose tolerance that does not reach the threshold for the diagnosis of diabetes, is commonly associated with both the metabolic syndrome and obesity. Prediabetes also has only a minor association with microvascular disease, but it is a stronger predictor of macrovascular disease.

The recommended therapeutic approach to these conditions is to aggressively treat all identified metabolic risk factors. Lifestyle interventions, blood pressure normalizations and lipid level reductions are the goals.

About five years ago, Apoor S. Gami, MD, and colleagues from the Mayo Clinic presented a review of the evidence linking metabolic syndrome and the risk of cardiovascular events, including death (J Am Coll Cardiol 2007;49:403-414). In 37 eligible studies that included more than 170,000 patients, increased risk remained after adjustment for traditional risk factors for cardiovascular disease.

A few years later, Salvatore Mottillo, BSc, and colleagues published a study that extended these observations to 87 studies including more than 950,000 patients (J Am Coll Cardiol 2010:56:1113-1132). They found that metabolic syndrome was associated with double the risk of cardiovascular events and 1.5 times the risk of all-cause mortality.

In an effort to address this growing clinical problem, the American College of Cardiology (ACC) is forming the Cardio-Metabolic Quality Care Alliance (CMQCA) in partnership with the American Association of Clinical Endocrinologists (AACE) and the National Minority Quality Forum (NMQF). The Association of Black Cardiologists also is joining the effort and other interested organizations will be invited as well. The mission of the CMQCA is fourfold:

  • To accelerate the translation of cardio-metabolic science into patient benefit;
  • To develop and communicate consensus positions on high-quality cardio-metabolic care;
  • To develop and implement unique data analysis solutions that support CMQCA activities; and
  • To advocate for better access to high-quality cardio-metabolic care.

The CMQCA will be led by national experts in cardio-metabolic disease serving under leaders appointed by the ACC,  AACE and NMQF. The assembled experts will have expertise in clinical science, health system design and health economics to devise authoritative guidance to the clinical, public policy, payer and patient communities on practical, evidence-based strategies for managing cardio-metabolic disease. They are supported by professional staff and the large-scale analytics resources of the ACC’s National Cardiovascular Data Registry. Over time, with the collaboration and efforts of many, the ACC hopes to eventually ameliorate the emerging cardio-metabolic disease epidemic.

Oetgen is senior VP of science and quality for the ACC.