A complex constellation of interrelated conditions

September 4, 2009

An estimated 47 million Americans have double the average risk of heart disease because they are affected by a complex constellation of interrelated conditions, including obesity, impaired glucose metabolism, hypertension, and lipid disorders.

An estimated 47 million Americans have double the average risk of heart disease because they are affected by a complex constellation of interrelated conditions, including obesity, impaired glucose metabolism, hypertension, and lipid disorders.1 These patients also are five times more likely to develop diabetes, according to the National Heart, Lung, and Blood Institute.1

This constellation of conditions-cardiometabolic disorders and weight-has become one of the most pressing public health issues today, affecting approximately a quarter of the U.S. population, accounting for a substantial proportion of healthcare and prescription drug spending, and threatening the vitality of an aging population.1,2 (See our series, http://www.modernmedicine.com/cardiodisorders , for a comprehensive overview.) Following is an examination of the key conditions.

OBESITY

Abdominal obesity is not only closely associated with the development of diabetes and hypertension, but is now thought to independently lead to cardiovascular disease. Recent research indicates that excess visceral adipose tissue releases metabolites, cytokines, chemokines, and hormones that influence inflammation and other factors to directly affect atherogenesis and the vessel wall.6

Experts agree that successful intervention requires more comprehensive patient education with interdisciplinary coordination among healthcare providers. Interventions are also taking place at an earlier age. In an effort to slow the obesity epidemic, 19 states have set stricter nutritional standards for school meals, 27 states have nutritional standards for foods sold in schools, and 20 now require body mass index screening or other weight assessment of schoolchildren.7

IMPAIRED GLUCOSE METABOLISM

In the United States, 17.9 million patients have diagnosed diabetes; an estimated 5.7 million remain undiagnosed, and an additional 57 million people have prediabetes, according to the American Diabetes Association.8 The incidence of diabetes among those aged 60 years or older is 23.1 percent. An estimated 16.5 percent of the adult American Indian and Alaska native population are affected by diabetes.8 After adjusting for age differences, the prevalence of diabetes is 11.8 percent among non-Hispanic blacks, 10.4 percent among Hispanic Americans, 7.5 percent in Asian Americans, and 6.6 percent among non-Hispanic whites.8

National prevalence data for type 2 diabetes among children and adolescents are not available. Overall, approximately 210,000 Americans aged <20 years have diabetes, an incidence of 0.26 percent, but the data do not differentiate between diabetes types.8 However, type 2 diabetes is being diagnosed more frequently in children, especially among Native Americans, African Americans, and Hispanic Americans. In addition, one in six overweight adolescents-approximately 2 million-have prediabetes.8

According to National Health Expenditure Account data, annual medical costs for patients with diabetes are $190.5 billion.9