Cardiometabolic Medicine: Development of a New Subspecialty

David R. Saxon; Cara Reiter-Brennan; Michael J. Blaha; Robert H. Eckel


J Clin Endocrinol Metab. 2020;105(7):2095-2104. 

In This Article

Epidemiology of Metabolic and Cardiovascular Diseases

Obesity rates began to rapidly increase in the 1980s and have continuously risen throughout the beginning of the 21st century. In the United States, as of 2015–16, obesity prevalence was 39.8% in adults and 18.5% in children.[3] In 2008, there were an estimated 1.46 billion adults worldwide with a body mass index (BMI) greater than 25 kg/m2, and 205 million men and 297 million women met the criteria for obesity.[4] It has recently been projected that by the year 2030, nearly 1 of every 2 adult Americans will have obesity and nearly 1 in 4 adults will have severe obesity, defined as a BMI >35 kg/m2 (Figure 1).[5]

Figure 1.

Estimated prevalence of overall obesity and severe obesity in each state, from 1990 through 2030. The estimated prevalence of overall obesity (A) and severe obesity (B) among adults in each US state from 1990 through 2030. Overall obesity includes the BMI (body mass index) categories of moderate obesity (BMI 30 to <35) and severe obesity (BMI ≥35). (Reproduced from: Ward ZJ, et al. N Engl J Med. 2019 Dec 19;381 (25):2440–2450).

The obesity epidemic has resulted in the drastic rise in other chronic metabolic conditions, such as T2DM, and an overall loss in quality-adjusted life years across all demographic categories.[6] Flattening of the rate of improvement of CVD and all-cause mortality is almost surely attributable to the rising trend in obesity in the United States.[7] Heart disease remains the leading cause of death for both men and women,[8] and globally CVD affects approximately 32.3% of all people with T2DM.[9] In patients with T2DM, the risk of death from coronary heart disease is 2.3 times higher than in those without T2DM and 60% to 75% of patients with T2DM die from CVD.[10,11] In Europe, a recent survey found that as many as two-thirds of patients with CVD were dysglycemic.[12] In recent years, cardiovascular outcomes trial results have brought about a remarkable change in the treatment of CVD risk in patients with T2DM such that it has become very difficult for one medical specialist or subspecialist to stay abreast with all new indications and potential adverse effects of new therapies. How can new innovations reach all of the right patients in as timely a fashion as possible?