The Urgent Need for Cardiometabolic Health Training: A Call to Action

Since Reaven's 1988 observation linking insulin resistance to both type 2 diabetes mellitus (T2DM) and cardiovascular diseases (CVD), additional abnormalities have been identified, later described collectively as metabolic syndrome (MetS), distinct from the previously termed cardiac syndrome X. Although inflammation is now recognized as central to these metabolic disturbances, components such as obesity, insulin resistance, dyslipidemia, and hypertension have long been associated with what we now call MetS. Despite evolving definitions of MetS, its clinical utility lies in identifying patients at elevated risk of CVD. Unfortunately, the incidence of MetS parallels the rising prevalence of both obesity and T2DM. While dietary and lifestyle interventions show promise at the individual level, more is needed from a healthcare systems perspective. The concept of cardiometabolic health (CMH) has recently emerged to raise awareness and guide best practices in promoting cardiovascular health and preventing adverse outcomes. Additionally, CMH aims to identify disparities in both diagnosis and care delivery, regardless of age, sex, ethnicity, or socioeconomic status. This effort is timely, as the decline in CVD mortality has stagnated, raising concerns about worsening risk factors or inequitable care access. Although not all pathophysiologic mechanisms linking MetS, T2DM, and CVD are fully elucidated, substantial evidence implicates genetic, epigenetic, environmental, and lifestyle factors. Particularly concerning are rising MetS rates among young adults and increasing prevalence in Hispanic and Asian populations. A central obstacle to addressing MetS, T2DM, and CVD is obesity. Given the demands of endocrinology and cardiology training programs, a new interdisciplinary field, cardiometabolic medicine (CMM), has emerged to address the complex needs of patients with overlapping cardiometabolic disorders. Although still evolving, CMM is essential for training future clinicians to address these escalating health challenges. Metabolic syndrome is a diagnostic risk construct, whereas cardiometabolic medicine is a clinical and training framework that incorporates MetS when present but extends beyond it to deliver integrated, life-course cardiovascular-renal-metabolic prevention and treatment.