The American Heart Association (AHA) Updates Metabolic Syndrome: Now it is the Cardiovascular-Kidney-Metabolic Syndrome
A Missed Opportunity for a Major Clinical Advance
The American Heart Association just released a new scientific statement that updates the concept of the metabolic syndrome. They missed a real opportunity to address the fact that all chronic diseases and aging are driven by the same epigenetic pathways and molecular biology. They are still thinking in terms of risk factors and individual organ systems when in fact the same epigenetic and biochemical factors damage the health of every cell and organ in the body. The sooner we recognize that basic fact and adjust our treatments accordingly, the more powerfully we will move to longer, healthier lives at lower cost.
The new Cardiovascular Kidney Metabolic Syndrome has a long history and I have immersed myself in this science because I focused on treating artery disease. Most patients with artery disease are overweight and somewhere on the path to diabetes. They progress from obesity to insulin resistance to high triglycerides and low good cholesterol, to hypertension, to prediabetes, to diabetes, to artery disease, chronic kidney disease, dialysis, cancer, autoimmune disease, osteoarthritis, and osteoporosis. It is all related. Increased inflammation and oxidant production are universally present and they also make us age more rapidly.
This concept was first popularized by Gerald Reaven beginning with his Banting lecture at the American Diabetes Association meeting in 1988 when he discussed the consequences of obesity and resistance to the effects of insulin. This concept is more than 35 years old. Reaven called this collection of findings the metabolic syndrome in the journal Circulation 21 years ago. Since then, it has been called several things— the insulin resistance syndrome, syndrome X, dysmetabolic syndrome, the metabolic syndrome, the cardiometabolic syndrome, the cardiorenal syndrome and now the cardiovascular kidney metabolic syndrome.
Adopting the idea of the metabolic syndrome has been even bumpier than naming it. A system organized around chronic disease risk factors and individual chronic diseases is a barrier. If all the conditions and organ damage that are listed are related, we would need an integrative advocacy organization to make more rapid progress. That is a clear and present threat to organizations like the American Heart Association and the American Diabetes Association. In fact, the American Diabetes Association aggressively addressed that threat. In 2005, in a joint statement with the European Association for the Study of Diabetes they said: “we found that the metabolic syndrome has been imprecisely defined, there is a lack of certainty regarding its pathogenesis (cause) , and there is considerable doubt regarding its value as a CVD (cardiovascular disease) risk marker. Our analysis indicates that too much critically important information is missing to warrant its designation as a “syndrome.” Until much needed research is completed, clinicians should evaluate and treat all CVD risk factors without regard to whether a patient meets the criteria for diagnosis of the “metabolic syndrome.” That is a very aggressive attack on the idea that there is benefit in considering the ways that chronic diseases are related.
The cardiovascular kidney metabolic syndrome is a baby step on the way to a much broader reality. We should be discussing a Unified Hypothesis of Chronic Disease and Aging. That is the fastest scientific path to better health at lower cost. Every day that we wait, more people are getting sick and paying too much for the privilege. This entire site is devoted to the idea that most chronic diseases and aging are caused by the same normal genes that are inappropriately switched on by abdominal fat, smoking, environmental toxins, and aging itself. These genes are essential for fetal development but deadly when reactivated later in life.
These inappropriately activated genes increase oxidant production and inflammation leading to amplifying mechanistic target of rapamycin (mTOR) activity and diminishing AMPK activity. Those are the final common pathways of chronic disease and aging. The famous cardiologist Milton Packer said it this way: “However, regardless of how their actions are envisioned, it is now critical for physicians to reconceptualize SGLT2 inhibitors as organ-protective agents rather than glucose-lowering drugs.” Jardiance for diabetes is an SGLT2 inhibitor that switches on the survival switch AMPK. Lisinopril and losartan for high blood pressure, statins for cholesterol, and metformin and Jardiance for diabetes are medications that protect every organ and cell in the body by the same mechanism. Dr. Packer wrote this in the medical journal that dismissed the idea of the basic metabolic syndrome fifteen years ago.
Treating patients that have had a heart attack with optimal medical therapy including these medications for 5 years results in a ten fold reduction in cardiovascular and all-cause mortality over 5 years compared with patient who receive usual care—the care that most of us get. A reduction in all cause mortality means that we are reducing deaths from chronic disease beyond those that are caused by hear disease and related conditions like diabetes. The cardiovascular kidney metabolic syndrome concept is a barrier to adoption of a unifying hypothesis of chronic disease and aging. Don’t be fooled. Let’s get started.
They missed the root cause of fatty liver, excessive belly fat, and hyperinsulinemia. They have missed the opportunity for five decades. They are doing the same thing again! It is not enough to lip service the true value of early detection and primary lifestyle optimization measure to deter and reverse chronic diseases for cures. It is how the nutrient sensing system (mTOR and AMPK) is properly and Thoroughly analyzed to design the optimal diet and lifestyle for the individuals to optimize the energy production and consumption on the cellular level, metabolically.
I have lost all respect for these giant medical complexes, especially the past 4 years. Disgusting