Author + information
- Received August 19, 2019
- Revision received November 6, 2019
- Accepted November 17, 2019
- Published online February 3, 2020.
- Jeffrey I. Mechanick, MDa,∗ (, )@drmikefarkouh,
- Michael E. Farkouh, MD, MScb,
- Jonathan D. Newman, MD, MPHc and
- W. Timothy Garvey, MDd,e
- aZena and Michael A. Wiener Cardiovascular Institute/Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, Icahn School of Medicine at Mount Sinai, New York, New York
- bPeter Munk Cardiac Centre and the Heart and Stroke Richard Lewar Centre, University of Toronto, Toronto, Ontario, Canada
- cDivision of Cardiology and Center for the Prevention of Cardiovascular Disease, Department of Medicine, New York University Medical Center, New York, New York
- dDepartment of Nutrition Sciences and Diabetes Research Center, University of Alabama at Birmingham, Birmingham, Alabama
- eGeriatric Research Education and Clinical Center, Birmingham VA Medical Center, Birmingham, Alabama
- ↵∗Address for correspondence:
Dr. Jeffrey I. Mechanick, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1030, New York, New York 10029.
• The cardiometabolic-based chronic disease model is designed to optimize early and sustainable preventive care.
• Genetics, environment, and behavior are primary drivers, and adiposity and dysglycemia are metabolic drivers of cardiometabolic-based chronic disease.
• Cardiometabolic endpoints include coronary heart disease, heart failure, and atrial fibrillation.
• A detailed prevention plan can be fashioned based on this model.
A new cardiometabolic-based chronic disease (CMBCD) model is presented that provides a basis for early and sustainable, evidence-based therapeutic targeting to promote cardiometabolic health and mitigate the development and ravages of cardiovascular disease. In the first part of this JACC State-of-the-Art Review, a framework is presented for CMBCD, focusing on 3 primary drivers (genetics, environment, and behavior) and 2 metabolic drivers (adiposity and dysglycemia) with applications to 3 cardiovascular endpoints (coronary heart disease, heart failure, and atrial fibrillation). Specific mechanistic pathways are presented configuring early primary drivers with subsequent adiposity, insulin resistance, β-cell dysfunction, and metabolic syndrome, leading to cardiovascular disease. The context for building this CMBCD model is to expose actionable targets for prevention to achieve optimal cardiovascular outcomes. The tactical implementation of this CMBCD model is the subject of second part of this JACC State-of-the-Art Review.
- atrial fibrillation
- chronic disease
- insulin resistance
- type 2 diabetes
Dr. Mechanick has received honoraria for lectures from Abbott Nutrition International. Dr. Farkouh has received research grants from Amgen, Novartis, and Novo Nordisk. Dr. Newman has received research grants from the National Institutes of Health National Heart, Lung, and Blood Institute K23HL125991; and has received honoraria from Creative Educational Concepts. Dr. Garvey has served on ad hoc advisory boards for Sanofi, Novo Nordisk, Boehringer Ingelheim, Gilead, Amgen, BOYDSense, and the American Medical Group Association; and has conducted research sponsored by the University of Alabama at Birmingham funded by Sanofi, Merck/Pfizer, Novo Nordisk, AstraZeneca, and Lexicon.
- Received August 19, 2019.
- Revision received November 6, 2019.
- Accepted November 17, 2019.
- 2020 American College of Cardiology Foundation
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