Cardiometabolic Medicine: Development of a New Subspecialty

Abstract

Context The worldwide rise in the prevalence of cardiometabolic disease, and the introduction of therapeutic options for treating metabolic disease that also lower cardiovascular risk, calls for a restructuring of how we care for patients with cardiometabolic disease. We propose establishment of a new medicine subspecialty, Cardiometabolic Medicine. Evidence Acquisition This summary is based on a synthesis of published original and review articles identified through PubMed, professional society guidelines, and the authors’ knowledge of the fields of metabolism, diabetes, and cardiology. Evidence Synthesis The growing prevalence of cardiometabolic disease will continue to be perhaps the greatest challenge in the United States and throughout the world. We have entered an era where a large set of clinical tools are available that help prevent and treat cardiometabolic disease; however, our old models of clinical training and siloed care are barriers to rapid uptake and efficient healthcare delivery and are in need of change. Conclusions Establishing the field of Cardiometabolic Medicine would be a small step in the right direction towards providing the best possible comprehensive care for those with complex cardiometabolic disease.

Attainment of Lipid Targets Following Coronary Artery Bypass Graft Surgery: Can We Do Better?

“…The establishment of a new cardiometabolic speciality, with integration into inpatient cardiothoracic units, cardiac units, and outpatient clinics, could potentially bridge the gap in lipid management and FH detection. 25 26 Cardiometabolic services can assist in providing a more comprehensive approach to managing complex lipid and lipoprotein disorders, such as facilitating the initiation of preventative therapies (e.g., PCSK9 inhibitors or newer therapies that are under development or currently undergoing CVD outcome trials, such as inclisiran or therapies targeting lipoprotein[a]). 25 26 In addition, the cardiometabolic speciality can help support a more comprehensive patient-centred approach to cardiovascular risk reduction.…”

“… 25 26 Cardiometabolic services can assist in providing a more comprehensive approach to managing complex lipid and lipoprotein disorders, such as facilitating the initiation of preventative therapies (e.g., PCSK9 inhibitors or newer therapies that are under development or currently undergoing CVD outcome trials, such as inclisiran or therapies targeting lipoprotein[a]). 25 26 In addition, the cardiometabolic speciality can help support a more comprehensive patient-centred approach to cardiovascular risk reduction. Collaboration between cardiometabolic and cardiothoracic services may provide a solution for optimising lipid care before and after CABG surgery.…”

Glucagon-like peptide-1 Receptor Agonists and the Cardiorenal Axis in Type 2 Diabetes: A Focus On Dulaglutide

“…The increasing overlap in management approaches and therapeutic options for these diseases suggests a new medical specialty -Cardiometabolic Medicine -is needed. This would be best placed for the holistic management of patients with metabolic diseases and related primary or secondary prevention of CV disease [79].…”

The Reply

“…While shortening college or medical school remains a separate issue worth discussing, 3 we believe that a new Cardiometabolic specialty could be time-saving for many. 4 Of note, we have received the opposite feedback as well − how could you learn critical aspects of endocrinology, metabolism, cardiology, and atherosclerosis imaging in just 3 years?…”

“…In 2020, there is no way for a trainee interested in this field to obtain the necessary training with any less than 4 years after Internal Medicine residency, and even so this would require tremendous individual planning.While shortening college or medical school remains a separate issue worth discussing, 3 we believe that a new Cardiometabolic specialty could be time-saving for many. 4 Of note, we have received the opposite feedback as well − how could you learn critical aspects of endocrinology, metabolism, cardiology, and atherosclerosis imaging in just 3 years?We are certain it could be done, and that it should be done.…”