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Commencing Volume 19, Issue 1, MedReviews has ceased the publication of this journal. Reviews in Cardiovascular Medicine will continue to be published by IMRPress, Ltd. (www.imrpress.org)

Volume 8, Supplement 4, 2007

Volume 8, Supplement 4, 2007

Table of Contents

The Progression of Cardiometabolic Risk to Cardiovascular Disease Understanding Cardiometabolic Risk
A cluster of risk factors associated with obesity defines the metabolic syndrome and identifies cardiometabolic risk. Accumulation of fat in the visceral depot is a more reliable predictor of cardiovascular disease than is total body mass or body mass index. The recent discovery of the endocannabinoid-CB1 receptor system and its impact on the regulation of energy metabolism represents a significant advance that will help target visceral fat and its metabolic implications. As a highly active endocrine organ, visceral fat secretes many bioactive molecules, known as adipokines. Dysregulation of these adipokines contributes to the pathogenesis of the obesity-associated metabolic syndrome, resulting in insulin resistance, type 2 diabetes, hypertension, hyperlipidemia, and vascular disease. Even modest weight reduction leads to reduced cardiometabolic risk by affecting the individual components comprising the metabolic syndrome. [Rev Cardiovasc Med. 2007;8(suppl 4):S3-S8]
Identification of Appropriate Patients for Cardiometabolic Risk Management Understanding Cardiometabolic Risk
Patients at increased risk for cardiovascular disease have a wide array of clinical features that should alert practitioners to the need for risk reduction. Some, but not all, of these features relate to insulin resistance. Multiple approaches exist for diagnosing and defining this risk, including the traditional Framingham risk assessment, various definitions of the metabolic syndrome, and assessment of risk factors not commonly included in the standard criteria. This article reviews the many clinical findings that should alert healthcare providers to the need for aggressive cardiovascular risk reduction. [Rev Cardiovasc Med. 2007;8(suppl 4):S9-S16]
Unmet Needs in Controlling Metabolic Disease Understanding Cardiometabolic Risk
In the past 10 years, there has been interest in a “metabolic syndrome” that might be associated with cardiovascular disease or diabetes. The first sets of criteria differed markedly, and their accuracy was equivocal. More recent definitions may be an improvement over previous ones. The metabolic syndrome may be most useful as a predictor of cardiovascular disease in nondiabetic subjects. It encourages healthcare providers who are confronted with a single risk factor to look for others. When multiple risk factors are found, it promotes consideration of behavioral interventions, such as weight loss and increased physical activity, instead of a pharmacological treatment for each risk factor. Such behavioral interventions were more effective than metformin in reducing the incidence of diabetes and of other components of the metabolic syndrome in one randomized, controlled study. [Rev Cardiovasc Med. 2007;8(suppl 4):S17-S24]
A Practical Approach to Reducing Cardiovascular Risk Factors Understanding Cardiometabolic Risk
Despite overwhelming evidence supporting the benefits of cardiovascular protective therapies and risk reduction in patients with or at risk for coronary heart disease, these strategies remain underutilized in clinical practice. Preventive cardiology guidelines from the American Heart Association, the American College of Cardiology, and others focus on primary and secondary prevention with the use of medications, risk factor control measures, and lifestyle modification. Still, a “treatment gap” remains between the guidelines and their actualization. A systematic approach including both inpatient and outpatient measures is necessary. This article discusses the current guidelines and addresses ways to increase implementation of evidence-based, guideline-recommended treatment by healthcare providers caring for at-risk patients. [Rev Cardiovasc Med. 2007;8(suppl 4):S25-S36]
Novel Therapies for Cardiometabolic Risk Reduction and Implications for Clinical Practice Understanding Cardiometabolic Risk
The growing prevalence of obesity is associated with a dramatic increase in a number of related risk factors for cardiovascular disease and diabetes, including high triglyceride and fasting glucose levels, reduced high-density lipoprotein cholesterol, and increased blood pressure. For many patients, lifestyle interventions (eg, exercise and a reduced-calorie diet) are insufficient for overcoming obesity, and pharmacotherapy becomes necessary. Unfortunately, the currently available agents are associated with side effects such as gastrointestinal distress and increased blood pressure. A new class of drugs targeting the cannabinoid receptors is poised to join the obesity-management armamentarium, with one agent—rimonabant—demonstrating efficacy in 4 recent phase III multinational trials. Patients randomized to rimonabant 20 mg/d showed significant reductions in weight and significant improvements in lipid profiles and other measures of cardiometabolic risk factors. [Rev Cardiovasc Med. 2007;8(suppl 4):S37-S42]