Holistic treatment of cardiometabolic diseases such as diabetes mellitus and dyslipidemia.
The creation of a cardiometabolic clinic in central service points is an important step towards the upgrading of health services as specialized medical and nursing staff with many years of hospital experience and state-of-the-art equipment is made available to our fellow citizens.
The number of patients with diabetes mellitus is constantly increasing and is estimated to reach 580 million worldwide in a decade. Atherosclerotic disease and cardiovascular disease represent the leading cause of death in patients with diabetes.
Diabetes mellitus promotes cardiac processes such as left ventricular hypertrophy, endothelial dysfunction, interstitial fibrosis, and microvascular damage. Factors that both favor and impede the management of heart disease.
The goal of the cardiometabolic clinic is to provide comprehensive and thorough treatment of heart disease, diabetes mellitus and other risk factors such as hypercholesterolemia and arterial hypertension.
The patient's admission to the cardiometabolic clinic is guided under dual medical supervision and is examined in parallel by both a cardiologist and a cardiologist-diabetologist. The collaboration of doctors of these two specialties aims at a thorough and holistic assessment, stratification of cardiovascular risk and effective control of problems by pharmaceutical or interventional means.
The hospital team of the cardiology clinics of our hospitals (Hygeia & Metropolitan Hospital) consists of clinical and interventional cardiologists, pathologists-diabetologists, offering services such as:
- Continuous glucose measurement
- Dynamic echocardiography with dobutamine (stress-echo)
- Pacemaker/defibrillator monitoring clinic
- 24-hour or 48-hour recording (holter) of heart rate and blood pressure
1. What is cardiometabolic syndrome?
Cardiometabolic or metabolic syndrome is the clinical coexistence of metabolic disorders that can lead to the long-term development of cardiovascular disease and diabetes, which include insulin resistance and impaired glucose tolerance (prediabetes and type 2 diabetes), atherogenic dyslipidemia, arterial hypertension and central obesity. The pathological disorders used to define the syndrome are also considered pathogenic mechanisms. Over 25% of the adult population worldwide has cardiometabolic syndrome.
2. How is cardiometabolic syndrome diagnosed?
At least 3 of the following risk factors are required for diagnosis:
| High glucose |
Above 100 mg/dL fasting glucose or a positive glucose tolerance test. |
| High blood pressure | 130/85 or higher or taking antihypertensive medication |
| High fasting triglycerides | 150 mg/dL or taking hypolipidemic treatment |
| Low HDL cholesterol |
Men: less than 40mg/dL |
| Waist circumference |
Men: Above 102 cm Women: over 88 cm |
3. Which individuals are at increased risk for cardiometabolic syndrome?
Those with excess weight, especially with peri- and intra-abdominal fat accumulation, sedentary lifestyle, hypercaloric diet, genetic predisposition. In addition, women with polycystic ovary syndrome, women with a history of gestational diabetes, women with infertility, people with sleep apnea and sleep disorders, people with long or irregular work schedules, people with psychotic and emotional disorders (bipolar disorder, depression, schizophrenia), autoinflammatory diseases such as psoriasis, rheumatoid arthritis or systemic lupus erythematosus, people with fatty liver disease.
4. What are the complications of cardiometabolic syndrome?
Cardiovascular diseases, such as coronary artery disease, vascular strokes, peripheral vascular disease, chronic kidney disease, retinopathy, diabetic neuropathy, diabetic foot, are the most common complications. More recently, however, the involvement of insulin resistance syndrome, especially when it coexists with obesity, in the development of several common cancers (breast, endometrial, colorectal, pancreatic), steatohepatitis and cirrhosis, infertility, lung disorders, arthritis, etc., has been recognized, while the syndrome itself is a distinct risk factor for worse prognosis and response to treatment in these conditions.
5. What does a cardiometabolic clinic offer?
A cardiometabolic clinic/centre is an innovative development in preventative cardiology. It is essentially a structure in which health professionals of different specialties work together to provide holistic treatment of the patient with metabolic syndrome and associated cardiovascular diseases, both as primary and secondary prevention. The innovation lies in the simultaneous monitoring of patients by a cardiologist and an endocrinologist/diabetologist with specialized experience and knowledge of the latest scientific data in the management of metabolic syndrome , in the direct on-site laboratory and imaging tests and on-site evaluation of these by the therapeutic team, and in the joint consultation based on the results, so that the patient does not have to seek a solution in different medical practices.
6. What does a cardiometabolic clinic involve?
The endocrinology/metabolic part includes physicians and nutritionists specialized in the treatment of obesity and related metabolic disorders and their complications, namely diabetes mellitus, dyslipidemia, hypertension, steatohepatitis, and other endocrine disorders affecting metabolism. In addition, the scientific team should be involved in clinical nutrition and identification of any eating disorders as well as lifestyle coaching with specific and individualized instructions on nutrition/exercise/modification of daily habits/smoking cessation/mental health/preconception counselling (counselling for women of reproductive age), tailored to the specific needs and capabilities of each patient, rather than simply as general instructions that are difficult to implement and easily frustrating.
The cardiology section focuses on both primary and secondary prevention of atherosclerotic cardiovascular disease, with the performance of specific tests such as stress ultrasound, coronary angiography, peripheral vascular screening, and the possibility of immediate hospitalisation and therapeutic interventions where necessary.
7. What specific areas does a cardiometabolic clinic/centre aim to address?
Cardiometabolic syndrome affects at least 10-20% of adults worldwide. Patients with diabetes/prediabetes/obesity are 2-4 times more likely to develop cardiovascular complications. Although metabolic disorders and cardiovascular disease are closely related, they are rarely treated simultaneously and in a holistic manner. It is crucial that patients receive a treatment approach that aims not only at glycaemic/dyslipidaemia control etc. but mainly at primary and secondary prevention of cardiovascular disease.
Fragmented monitoring and lack of communication between the different specialties creates confusion and lack of compliance to treatment for the patient. The simultaneous treatment of metabolic disorders and cardiovascular protection by a specialized healthcare team can not only lead to effective prevention of complications and immediate treatment decisions, but can also facilitate the patient to access specialized healthcare services without having to visit several different departments and getting lost along the way, especially in times when access to the healthcare system is difficult and multiple appointments for clinical and paraclinical care are required, especially in times when access to the healthcare system is difficult and multiple appointments for clinical and paraclinical
For these reasons, a cardiometabolic clinic is an international trend that is gaining momentum and has been proven to improve both patient outcomes and quality of life.