Novel Approaches for Early Diagnosis and Prevention of Cardiometabolic Diseases

Abstract

Metabolic diseases such as hypertension, excess weight, obesity, and diabetes have increased to epidemic proportions globally in the last four decades and contributed significantly to the excess morbidity and mortality. Cardiovascular diseases (CVDs) rank as number one killers, with over 17.8 million deaths/year worldwide. Framingham heart studies have meticulously described the risks, that promote the progression of cardiometabolic diseases. Based on this information, professional societies have developed appropriate guidelines, for the management of observed risks, that contribute to the progression of these diseases. Pharma companies have developed drugs, that are effective for the management of the observed metabolic alterations, such as blood pressure (BP), altered lipids, and glucose metabolism. Many clinical trials such as MONICA, Seven Countries Studies, and INTERHEART and INTERSTROKE, have demonstrated, that robust management of the modifiable risk factors, increased physical activity, and heart-healthy diet, reduces the risk of CVD and prevents premature mortality. Despite these observations, no country has reduced, reversed, or prevented the increase in the incidence of cardiometabolic diseases. As a part of a collaboration between the researchers of the South Asian Society on Atherosclerosis and Thrombosis (www.sast.org), USA, and the Division of Biosciences and Health Sciences, Ashoka University, India, we would like to develop early diagnostic and prevention strategies, to reduce reverse or prevent the progression of risks, for the development of cardiometabolic diseases. Our focus would be to develop better methods, such as early detection of deterioration in blood flow dynamics and the use of continuous BP monitoring, to optimize diagnosis of prehypertension and prevention or early treatment of hypertension. We and others believe that the earliest sign of vascular disease is the development of endothelial dysfunction, leading to the alterations in blood flow dynamics. Yet we do not have a simple cost-effective tool, to monitor altered flow dynamics in microvascular and macrovascular flow in various regional vascular beds. We will develop simple cost-effective noninvasive technologies for studying blood flow dynamics. The currently used gold standard for monitoring coronary blood flow is Doppler ultrasound. We would use this known technology and develop capabilities for determining blood flow dynamics in regional vascular beds. As far as for management of diabetes, clinicians use fasting blood glucose or glycated hemoglobin as the gold standard. We would develop robust clinical data and show the benefits and superiority of using continuous glucose monitoring by using continuous glucose monitors (CGM), to optimize the benefits of a healthy diet, exercise, and lifestyle changes, starting before the onset of diabetes. Furthermore, the use of this emerging technology will empower patients to know the effect of lifestyle changes on their blood glucose in real-time. The development of robust data on this approach will help promote the use of CGM by type-2 diabetics as well as prediabetics. Recommendations by clinicians and researchers will expand the use of this useful technology by a wider population as well as bring down the cost of the disposable sensor used for monitoring interstitial glucose. Framingham Heart Group laid the foundation for preventive cardiology 70 years ago. It is high time; we develop early diagnostic and preventive strategies, instead of just focusing on the management of cardiometabolic risks.