Preventive cardiology or cardiometabolic medicine: a new and emerging subspecialty?

While we have seen great reductions in cardiovascular disease (CVD) morbidity and mortality over the past few decades, the rate of these declines has recently diminished, and there is even evidence that CVD mortality may be on the rise once again [1]. Much of this is fueled by the epidemic of obesity, metabolic syndrome and type 2 diabetes [2]. There is a wealth of evidence regarding the efficacy of cholesterol-lowering medications (particularly statins), blood pressure control, and most recently the treatment of diabetes with newer medications that positively impact CVD outcomes [2]. Yet recent data continue to demonstrate inadequate adherence to preventive medications and inadequate control of risk factors [3,4]. Even in the case of diabetes, where CVD is the major cause of morbidity and mortality, while many patients are at reasonable targets for HbA1c, blood pressure, and low-density lipoprotein-cholesterol individually, 20% or fewer are at all three targets simultaneously, suggesting a lack of coordinated care and understanding of the priorities that should be placed to reduce CVD risk in such persons [5]. Moreover, there is a continued rise in obesity both in developing and developed nations, with this closely linked to other cardiometabolic risk factors such as blood pressure and dyslipidemia, as well as being a strong determinant of type 2 diabetes. Consequently, there is an urgency for healthcare providers from different specialties to come together to address together the CVD risks common in many patients if we are to reduce, or at least prevent an imminent rise in CVD morbidity and mortality moving forward. While clearly there has been great progress made in the treatment of persons with known CVD, if we are to make further progress in the next few decades, there needs to be a shift in focus in cardiovascular medicine towards promoting cardiovascular health and prevention. A specialized field of preventive cardiology or cardiometabolic medicine [2] is meant to address this need.