The global epidemics of obesity and diabetes carry with them major issues regarding cardiovascular (CV) complications. In addition to the obvious challenges posed by the magnitude of these problems, fundamental questions exist regarding the intersection of abnormal metabolism and CV disease. Despite strong evidence linking hyperglycemia and A1c levels with CV risk, the impact of antidiabetic therapies on reducing CV events has been disappointing. Although progress in CV therapeutics has been considerable, these advances have not had the same impact among those with diabetes as compared to those without it. An alarming percentage of patients experiencing acute coronary syndromes and stroke appear to have undiagnosed type 2 diabetes or prediabetic states. At the same time, perhaps the greatest impact on reducing CV events in type 2 diabetes is by early intervention in the natural history of type 2 diabetes, even though controversy persists about how to define or intervene in these early stages of metabolic abnormalities. Type 2 diabetes is now seen among adolescents, raising major concerns about the CV risk in these young individuals, and the prospect of a generation that may not outlive their parents.
Separate from CV benefit, new CV safety standards have been implemented for regulatory approval of antidiabetic agents. The molecular mechanisms underpinning all of these cardiometabolic issues remain obscure, although countered by an onslaught of new molecular insights into adiposity, glucose homeostasis, and atherosclerosis, including the identification of new therapeutic targets. Indeed, it remains unclear if atherosclerosis in the context of diabetes versus non-diabetes is fundamentally the same or different. Together these and other dilemmas at the juncture of cardiology and metabolism establish the need for new, integrated approaches to cardiometabolic issues and disorders. It is at this intersection that Hot Topics in Cardiometabolic Disorders will seek to stand.
This new editorial enterprise will provide a continuing series of articles focused on specific thematic topics relevant to cardiometabolic issues. In the most rigorous manner possible, international authorities will tackle cutting edge issues regarding diabetes, obesity, dyslipidemia, and CV disease, offering unique perspectives on these problems and evolving advances that might offer therapeutic solutions. The topics under discussion—ranging from how targeting new pathways in glucose control might impact CV disease to the cardiometabolic effects of existing antihypertensive drugs to new understanding of cardiometabolic pathology to perspectives on recent antidiabetic CV trials—will be of obvious relevance to this emerging field. Indeed, these presentations will be of inherent value to practicing clinicians who face this intersection of CV disease and metabolic abnormalities in their patients every day.