Interview: The Role of Primary Care in the Management of Cardiometabolic Disease
Cardiometabolic risk reduction is at the core of nearly every clinician’s practice, given the prevalence of these conditions—hypertension, diabetes, dyslipidemia, and obesity—among the U.S. population. Nearly 10% of American adults have diabetes, nearly 30% have high blood pressure, and nearly 35% are obese, meaning that helping patients manage their cardiometabolic health is likely one of the most common components of daily practice.
Consultant sat down with Daniel Einhorn, MD, FACP, FACE, and Peter H Jones, MD, FACP, FNLA, to discuss their perspectives on key issues contributing to the growth of the cardiometabolic disease epidemic, why primary care clinicians are critical to the management of patients with these conditions, and how the Cardiometabolic Risk Summit (CRS), the official meeting of Consultant, provides vital education that will change the way primary care clinicians manage cardiometabolic disease in daily practice.
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Dr. Einhorn serves as Medical Director of the Scripps Whittier Diabetes Institute, Associate Editor of the Journal of Diabetes, and President of Diabetes and Endocrine Associates. He is also Clinical Professor of Medicine at the University of California, San Diego. He received his medical degree from Tufts University School of Medicine.
Dr. Jones serves as Co-director of the Lipid Metabolism and Atherosclerosis Clinic, and as Medical Director for the Weight Management Center in the Houston Methodist Diabetes and Metabolism Institute. He is also Associate Professor in the Department of Medicine, Center for Cardiovascular Disease Prevention, at Baylor College of Medicine in Houston, Texas. He received his medical degree from the Baylor College of Medicine as the Micheal E. DeBakey Scholar.
Both Drs. Einhorn and Jones participate as Co-chairs for the Cardiometabolic Risk Summit (CRS), the official meeting of Consultant, taking place from October 20-22, 2017, in Dallas, Texas.
Q: What do you feel are the key issues contributing to the continued growth of cardiometabolic disease epidemic in the US?
Dr. Einhorn: New ideas include the impact of early-in-life antibiotic exposure on the microbiome, which may impact inflammatory pathways for life, and the interaction of all metabolic diseases. Also, better understanding of the effect of high prevalence of fructose throughout the processed food chain, the changing ethnic mix of America, and all the usual suspects from prior years. That being surrounded by obesity creates an interesting paradigm, with both psychological and physiological aspects.
Dr. Jones: The convergence of inexpensive, calorie-dense, nutrition-poor food availability and a lack of daily physical activity has led to a greater incidence of obesity across the U.S. population. This results in more metabolic disturbances, such as hypertension, diabetes, and dyslipidemia, and can lead to premature cardiovascular events. Racial and socioeconomic disparities as factors also need to be addressed.
Q: What is the biggest misconception about cardiometabolic syndrome?
Dr. Einhorn: That it’s just diabetes, obesity, fats and blood pressure. It’s perhaps as much about everything else we know about chronic disease in the modern age. Specifically, it’s also about stress, sleep, environmental change, disruption of natural living rhythms and diet, and physical activity. It’s also a misconception that our drug therapies alone can reverse all aspects of cardiometabolic syndrome.
Dr. Jones: Cardiometabolic syndrome has genetic influences; however, patients and healthcare providers need to understand that the manifestations of insulin resistance, dyslipidemia, obesity and hypertension are also strongly influenced by modifiable lifestyle habits.
Q: Why are primary care clinicians so critical in the management of patients with cardiometabolic risk factors? Particularly in rural areas and/or special populations?
Dr. Jones: Primary care providers are the front-line practitioners responsible for screening and identifying at-risk patients at a young age. This is the prime time for education concerning optimal dietary patterns and physical activity to be most likely to result in sustainable metabolic benefits, rather than trying to institute these changes at a later age after a medical event has already occurred.
Q: Can you elaborate on the importance of a team or multidisciplinary approach to the management of cardiometabolic disease in patients?
Dr. Einhorn: Because they are the front lines, the ones who see the most people in need. The specialists help define the path because that’s what they do. The primary care clinicians make it real. They teach the rest of us what’s important and what’s doable in daily practice.
Dr. Jones: Since there is a strong need for patients with cardiometabolic disease to have education and support that will facilitate long-term lifestyle and behavioral change, a team of providers (MD/DO, PA/NP, RD, CDE, exercise physiologist and licensed counselors) is crucial for patient success.
Q: From your perspective, can you explain why CRS, with a scientific program focusing on practical strategies for the prevention and treatment of diabetes, dyslipidemia, obesity and hypertension, provides vital education and key take-homes that will change the way primary care clinicians manage cardiometabolic disease in their patients?
Dr. Einhorn: What’s different about CRS is the dialogue it fosters throughout the meeting — speaking WITH each other, not AT each other. Attendee experiences, observations and questions are highly valued and become a key component of the learning experience at CRS.
The CRS co-chairs and presenters are tasked to impart the very latest updates in clinical data, guidelines, and therapies, combined with the practical experience of clinicians. Each of us is involved in patient care, so we understand the joys and tribulations of caring for patients with cardiometabolic disease in daily practice.
Dr. Jones: The Cardiometabolic Risk Summit (CRS) offers blocks of programming focused on the main clinical features of cardiometabolic disease — diabetes, dyslipidemia, hypertension and obesity — and each has practical lectures that discuss the latest diagnostics and pharmacologic therapies. Within the program are industry-supported symposia that also focus on the newest therapies. I also appreciate the meeting opening with a lecture on motivating the patient with cardiometabolic disease.
Q: What are you looking forward to most this year at CRS?
Dr. Einhorn: We are at a sea of change in diabetes care because of new clinical trials — especially on heart disease and diabetes — new therapies, and new technologies. I’m eager to discuss how we can make life so relatively good and so easy for our patients with diabetes and do it more effectively than ever.
Dr. Jones: I am first looking forward to hearing lectures from an amazing list of national speakers who are the best educators in their area of expertise. Second, and I must admit I am biased, the sessions on managing lipid disorders is a crucial area to understand the newest therapeutics to reduce CVD risk, and is delivered by an exceptional group of speakers/educators.
Q: What are the top reasons why you would encourage both new and former CRS attendees to register for this year’s meeting?
Dr. Einhorn: If you are new, welcome to the family. We care about our patients, we care to be the best possible in our communities, we’re fascinated by new data and new ideas, and we want to share in the dialogue between clinician and scientists that makes new knowledge relevant. It’s fun to be part of changing the medical world. If you have attended CRS before, get ready for the updates on what fascinated us since last year, what we think is important, and what may not be, and to glimpse what’s on the horizon for combating the cardiometabolic disease epidemic.
Dr. Jones: CRS is always the best meeting to attend each year to keep you abreast of the quickly evolving guidelines and therapies in all areas of cardiometabolic disease.
The Cardiometabolic Risk Summit (CRS) scientific program provides 3 full days of focused segments with targeted rapid-fire sessions presented by the experts in cardiometabolic disease. Each segment begins with a focus on the application of guidelines in daily practice, and then discusses various treatment options and dives into management of disease states in special populations. Each segment then concludes with a discussion on emerging treatments and late-breaking clinical trial information as well as dedicated attendee Q&A time as an opportunity to share additional insights. Learn more and view the full program at CombatTheEpidemic.com.