Cardiometabolic Risk in Canada: A Detailed Analysis and Position Paper by the Cardiometabolic Risk Working Group

doi:10.1016/j.cjca.2010.12.054

Canadian Journal of Cardiology

Volume 27, Issue 2, March–April 2011, Pages e1-e33

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https://doi.org/10.1016/j.cjca.2010.12.054 Get rights and content

Abstract

The concepts of “cardiometabolic risk,” “metabolic syndrome,” and “risk stratification” overlap and relate to the atherogenic process and development of type 2 diabetes. There is confusion about what these terms mean and how they can best be used to improve our understanding of cardiovascular disease treatment and prevention. With the objectives of clarifying these concepts and presenting practical strategies to identify and reduce cardiovascular risk in multiethnic patient populations, the Cardiometabolic Working Group reviewed the evidence related to emerging cardiovascular risk factors and Canadian guideline recommendations in order to present a detailed analysis and consolidated approach to the identification and management of cardiometabolic risk. The concepts related to cardiometabolic risk, pathophysiology, and strategies for identification and management (including health behaviours, pharmacotherapy, and surgery) in the multiethnic Canadian population are presented. “Global cardiometabolic risk” is proposed as an umbrella term for a comprehensive list of existing and emerging factors that predict cardiovascular disease and/or type 2 diabetes. Health behaviour interventions (weight loss, physical activity, diet, smoking cessation) in people identified at high cardiometabolic risk are of critical importance given the emerging crisis of obesity and the consequent epidemic of type 2 diabetes. Vascular protective measures (health behaviours for all patients and pharmacotherapy in appropriate patients) are essential to reduce cardiometabolic risk, and there is growing consensus that a multidisciplinary approach is needed to adequately address cardiometabolic risk factors. Health care professionals must also consider risk factors related to ethnicity in order to appropriately evaluate everyone in their diverse patient populations.

Résumé

Les concepts de « risque cardiométabolique », de « syndrome métabolique » et de « stratification du risque » s'entrecoupent et s'apparentent au processus et au développement de l'athérogénèse du diabète de type 2. Il y a confusion sur ce que ces termes signifient et sur la manière de mieux les utiliser pour améliorer notre compréhension du traitement et de la prévention de la maladie cardiovasculaire. Avec l'objectif de clarifier ces concepts et de présenter des stratégies pratiques pour identifier et réduire le risque cardiovasculaire chez les patients de populations multiethniques, le groupe de travail sur le métabolisme cardiaque a passé en revue les preuves liées aux nouveaux facteurs de risque cardiovasculaire et les recommandations des lignes directrices canadiennes pour présenter une analyse détaillée et une approche consolidée dans l'identification et la gestion du risque cardiométabolique. Les concepts liés au risque cardiométabolique et à la pathophysiologie, et les stratégies pour l'identification et la gestion (incluant les comportements de santé, la pharmacothérapie et la chirurgie) dans la population multiethnique canadienne sont présentés. Le « risque cardiométabolique global » est proposé comme terme générique dans une liste exhaustive de nouveaux facteurs et de facteurs existants qui prédisent la maladie cardiovasculaire et/ou le diabète de type 2. Les interventions sur les comportements de santé (perte de poids, activité physique, diète, désaccoutumance du tabac) chez les personnes à risque cardiométabolique élevé sont d'une importance critique étant donné la crise émergente associée à la croissance de l'obésité et les conséquences épidémiques du diabète de type 2. Les mesures de protection vasculaire (les comportements de santé chez tous les patients et la pharmacothérapie chez les patients appropriés) sont essentielles pour réduire le risque cardiométabolique, et il y a un consensus grandissant sur la nécessité d'une approche multidisciplinaire pour répondre adéquatement au risque cardiométabolique. Les professionnels de la santé doivent aussi considérer les facteurs de risque liés à l'ethnicité pour évaluer convenablement chacun des patients selon la diversité des populations.

Section snippets

Abstract......e1
Objectives and Methods......e2
Introduction to the Concepts of Cardiometabolic Risk, Metabolic Syndrome, and Risk Stratification: Finding the Forest Among the Trees......e2
Pathophysiology of Cardiometabolic Risk......e8
Identification of Cardiometabolic Risk......e9
Health Behaviour Interventions to Reduce Cardiometabolic Risk......e12
Pharmacologic and Surgical Interventions to Reduce Cardiometabolic Risk......e16
Cardiometabolic Risk in Susceptible Canadian Populations......e20

Objectives and Methods

The Cardiometabolic Risk Working Group is a national group of individuals with special interest in cardiometabolic risk and representative of the various related societies. In 2009, the Cardiometabolic Risk Working Group conceptualized the idea of organizing a consensus meeting that would be coupled with the publication of a position paper conceived with Canadian expertise and with direct and practical relevance for the diverse Canadian population and Canadian clinicians. In addition to

Introduction to the Concepts of Cardiometabolic Risk, Metabolic Syndrome, and Risk Stratification: Finding the Forest Among the Trees

G.B.J. Mancini, R. Ross, J. Cox, J.-P. Després, J. Genest, P.P. Liu, E.M. Lonn, S.W. Rabkin, J.A. Stone, and E. Ur

Atherogenesis is a complicated process. A panoply of mechanisms are at play, all of which are influenced by multiple factors, such as genetic predisposition or susceptibility, dyslipidemia, and oxidant state. Similarly, the genesis of type 2 diabetes is a complicated process. While many of the features and processes involved in the development of this disease overlap with the

Pathophysiology of Cardiometabolic Risk

S. Verma, R.E. Gilbert, R. Rabasa-Lhoret, and H. Teoh

The pathophysiological basis of cardiometabolic risk is complex. Although various mechanisms have been proposed, insulin resistance, particularly at the level of the fat, liver, and muscle coupled with visceral adiposity, and altered adipokine kinetics, appear to be closely associated with the clustering of abnormalities associated with increased cardiometabolic risk.

Identification of Cardiometabolic Risk

P.A. McFarlane, R. Lewanczuk, R. McPherson, and P. Poirier

Cardiometabolic risk refers to the sum of risk factors that increase an individual's risk of having a CV event or developing metabolic abnormalities such as type 2 diabetes (see Fig. 1). This risk is generated by traditional CV risk factors such as hypertension or smoking, by nontraditional risk factors such as insulin resistance, and by other genetic and clinical factors that are not fully understood. There is interplay between the

Health Behaviour Interventions to Reduce Cardiometabolic Risk

R. Ross, K. Camelon, J.-P. Després, D.W.C. Lau, and A.Y. Sharma

Cardiometabolic risk represents global CVD risk related to well-established risk factors (age, sex, family history, smoking, BP, LDL-C, HDL-C, diabetes) and emerging factors such as abdominal obesity and related metabolic abnormalities often referred to as metabolic syndrome. On that basis, traditional CVD risk factors should be managed by following current guidelines.11, 12, 90, 98, 99, 100, 101

Health behaviour modification is

Pharmacologic and Surgical Interventions to Reduce Cardiometabolic Risk

D.H. Fitchett, M. Gupta, L.A. Leiter, P.A. McFarlane, P. Poirier, J.-C. Tardif, A.W. Steele, and S. Tobe

The adoption of healthy behaviour is the most fundamental therapeutic strategy for the individual at increased cardiometabolic risk. Clinical trial evidence shows that weight loss and increased physical activity are very effective in reversing cardiometabolic risk. However, these health behaviour modifications are often difficult to achieve and sustain long-term. Thus, pharmacologic therapy

Cardiometabolic Risk in Susceptible Canadian Populations

M. Gupta, S. Anand, C.-M. Chow, S.B. Harris, S. Qaadri, and H. Teoh

Funding Sources

Funding for this project was provided by the following organizations in the form of unrestricted educational grants: AstraZeneca Canada Inc, Boehringer Ingelheim (Canada) Ltd, Bristol-Myers Squibb Canada, Eli Lilly Canada Inc, GlaxoSmithKline Canada, Hoffmann-La Roche Ltd, Merck Frosst Canada Ltd, Merck Frosst/Schering Pharmaceuticals, Novartis Pharmaceuticals, Novo Nordisk Canada, Pfizer Canada Inc, Sanofi-Aventis Canada Inc, and Servier Canada Inc. Corporate sponsors were not involved in the

Disclosures

All authors completed and signed a duality of interest disclosure detailing relevant financial interests, honouraria for CME, research funding, and consultant or advisory board membership for the past 12 months. Authors received an honourarium and were reimbursed for their travel and accommodation expenses to attend a Cardiometabolic Risk Working Group meeting in Toronto, Ontario. In addition, a token honourarium was offered to each author for his or her participation in the overall project and

Supporting Organizations

C-CHANGE, Canadian Cardiovascular Society, Canadian Diabetes Association, Canadian Institutes of Health Research, Canadian Obesity Network, The College of Family Physicians of Canada, Dietitians of Canada, Obesity Canada.

Acknowledgements

The authors thank medical writer and editor Cynthia N. Lank, Halifax, Nova Scotia, for her assistance in the development of the position paper, as well as the individual reviewers from each of the endorsing organizations, including Dr Vincent Woo from the Canadian Diabetes Association; Dr Richard Birtwhistle, Dr Peter J. Lin, Dr Kevin Saunders, and Dr Richard Ward from the College of Family Physicians of Canada; May Yee Jung, RD, CDE, and Daphna Steinberg, RD, from the Dietitians of Canada; and

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Position statementCardiometabolic Risk in Canada: A Detailed Analysis and Position Paper by the Cardiometabolic Risk Working Group

Abstract

Résumé

Section snippets

Table of Contents

Objectives and Methods

Introduction to the Concepts of Cardiometabolic Risk, Metabolic Syndrome, and Risk Stratification: Finding the Forest Among the Trees

Pathophysiology of Cardiometabolic Risk

Identification of Cardiometabolic Risk

Health Behaviour Interventions to Reduce Cardiometabolic Risk

Pharmacologic and Surgical Interventions to Reduce Cardiometabolic Risk

Cardiometabolic Risk in Susceptible Canadian Populations

Funding Sources

Disclosures

Supporting Organizations

Acknowledgements

Am J Med

J Am Coll Cardiol

Atherosclerosis

Atherosclerosis

J Am Coll Cardiol

J Am Coll Cardiol

Ann Epidemiol

Atherosclerosis

J Am Coll Cardiol

Atherosclerosis

J Am Soc Echocardiogr

Lancet

Can J Cardiol

J Am Coll Cardiol

Lancet

J Biol Chem

Lancet

J Clin Epidemiol

Int J Biochem Cell Biol

Drug Discov Today: Ther Strategies

Kidney Int

Can J Cardiol

Preventing cardiovascular disease and diabetes: a call to action from the American Diabetes Association and the American Heart Association

Circulation

The metabolic syndrome: time for a critical appraisalJoint statement from the American Diabetes Association and the European Association for the Study of Diabetes

Diabetes Care

Abdominal obesity and metabolic syndrome

Nature

Lipoprotein management in patients with cardiometabolic risk: consensus conference report from the American Diabetes Association and the American College of Cardiology Foundation

Diabetes Care

The concept of cardiometabolic risk: bridging the fields of diabetology and cardiology

Ann Med

Abdominal obesity: the most prevalent cause of the metabolic syndrome and related cardiometabolic risk

Eur Heart J Suppl

Banting lecture 1998Role of insulin resistance in human disease

Diabetes

Definition, diagnosis and classification of diabetes mellitus and its complicationsPart 1: diagnosis and classification of diabetes mellitus: provisional report of a WHO consultation

Diabet Med

Executive summary of the third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III)

JAMA

Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement

Circulation

The IDF consensus worldwide definition of the metabolic syndrome

Adverse prognosis associated with the metabolic syndrome in established coronary artery disease: data from the EUROPA trial

Heart

Diabetes, the metabolic syndrome, and angiographic progression of coronary arterial disease in postmenopausal women

Arterioscler Thromb Vasc Biol

The metabolic syndrome and incidence of cardiovascular disease in non-diabetic subjects: a population-based study comparing three different definitions

Diabet Med

Cardiovascular risk in the metabolic syndrome: fact or fiction?

Curr Cardiol Rep

The National Cholesterol Education Program: Adult Treatment Panel III, International Diabetes Federation, and World Health Organization definitions of the metabolic syndrome as predictors of incident cardiovascular disease and diabetes

Diabetes Care

Prognostic impact of metabolic syndrome by different definitions in a population with high prevalence of obesity and diabetes: the Strong Heart Study

Diabetes Care

Impact of body mass index and the metabolic syndrome on the risk of cardiovascular disease and death in middle-aged men

Circulation

Circulation

Simple scoring scheme for calculating the risk of acute coronary events based on the 10-year follow-up of the Prospective Cardiovascular Munster (PROCAM) study

Circulation

The rise and fall of the metabolic syndrome

Diabetologia

The metabolic syndrome: useful concept or clinical tool?Report of a WHO Expert Consultation

Diabetologia

Position statement
Cardiometabolic Risk in Canada: A Detailed Analysis and Position Paper by the Cardiometabolic Risk Working Group