Life’s only constant is change. The good thing about change is its ongoing opportunity to learn, adapt, begin again, and the opportunity to shape your future. Your body changes also — beyond what is visible in the mirror. A routine medical checkup turns into the detection of a little rise in blood pressure, an extra wave of afternoon fatigue, or a lab report with numbers that are technically “within normal limits” although raising concerns. For many, the journey to a cardiometabolic diagnosis like type 2 diabetes or heart disease doesn’t start with a sudden medical crisis but with quiet, often unnoticed, interconnected changes.
Today, let’s look at how the body’s health changes from “healthy” to risk factors, then a cluster of metabolic diagnosis, and ultimately cardiometabolic disease. Examination of the journey is pointless if you’re unable to affect change. While change may be inevitable, the path to the future can be limitless. Knowing the journey allows you to apply the brake and then shift the gears from driving straight into the unknown, to reverse or at a minimum, a lower gear to slow your roll to type 2 diabetes, heart disease, stroke, or other metabolic disorders. As the driver of your health, simple everyday steps are available to take more control. Cardiometabolic disease doesn’t happen overnight. Those on the road to metabolic disease are on a slow journey of years, allowing many opportunities to affect the diagnosis.
The journey begins before a single diagnosis
Before a diagnosis of cardiometabolic disease, the body presents with a cluster of signs and diagnoses called a cardiometabolic syndrome typically including three or more of the following diagnoses:
Central adiposity
Visually observed in the abdomen area, this fat is not just subcutaneous fat (fat found directly under the skin), but rather this fat is visceral and is a buildup of fat deep around internal organs in the abdominal cavity. Most importantly, this fat is metabolically active — that is it releases hormones and inflammatory chemicals that drive serious health risks like increases in blood pressure and insulin resistance.
Hypertension
Blood pressure changes throughout the day. It goes up with increased workload or stress, it comes down with relaxation — all of this is normal. When blood pressure readings are consistently captured at 130 / 80 mm Hg or higher, it’s diagnosed as hypertension (American Heart Association). High blood pressure is often called the “silent killer” as it has no outward visible symptoms while damaging the body. Unmanaged hypertension can lead to heart attacks, strokes, kidney disease, and vision loss.
Dyslipidemia
Lipids or cholesterol is a fat-like substance your body needs to build healthy cells, make hormones, and aid in food digestion. It’s important to remember that cholesterol is not inherently “bad” when balanced. When cholesterol levels begin to alter from healthy levels, it becomes a problem that is made more confusing with labels of “good” or “bad” cholesterol. The first red flag is too much of the “bad” cholesterol — triglycerides, low density cholesterol, and very low density cholesterol — and not enough of the “good” cholesterol — high density cholesterol. The ratios of these cholesterols frequently determine cholesterol health status.
Elevated blood glucose
When a person has an elevated blood glucose or blood sugar while in a fasting state (nothing to eat or drink for 6 – 8 hours), it’s called “impaired fasting glucose” and serves as a red flag to the body’s inability to control glucose levels. Like blood pressure, blood glucose changes throughout the day. While it’s normal for consumed carbohydrates to raise blood glucose levels, blood glucose levels outside normal limits can add to an inflammatory state. The longer blood glucose levels exist above normal limits, the greater the chances of complications.
Insulin resistance
The foundational disfunction of type 2 diabetes in insulin resistance. Insulin resistance is when the body’s cells do not respond to insulin correctly. That is, the body makes insulin, but the insulin cannot be used. Insulin levels and blood glucose in the blood stream increase, adding to the inflammatory response and making weight loss more difficult.
It’s difficult to say what came first. Just like the chicken or the egg, which condition came first on the road to cardiometabolic syndrome doesn’t matter that much. The cardiometabolic patient journey begins with a foundation of risk factors triggering systemic inflammation and supporting a list of health complications most of us would like to avoid.
Understanding cardiometabolic risk
We shift gears on the road to cardiometabolic disease by addressing the risk factors of the conditions that fall under the cardiometabolic “risk” umbrella including:
Type 2 Diabetes Mellitus
- 45+ years of age
- Family history / genetics
- Race or ethnicity: People of African American, Hispanic, Asian, or Native American descent
- History of gestational diabetes or birth of 9+ lb. baby
- Inactivity
- Central adiposity or BMI 26 or greater
- Elevated blood pressure, triglycerides, and low HDL
- Polyendocrine Metabolic Ovarian Syndrome (PMOS) or PCOS (Polycystic Ovary Syndrome)
ASCVD, Stoke, Heart Disease
- Older age
- Family history / genetics
- Women post menopause
- Men have higher risk at younger ages
- High blood pressure
- High cholesterol
- Smoking
- Diabetes & pre-diabetes
- Obesity
- Inactivity
- High fat, high sodium, low fiber diet
Kidney Disease
- Older age
- Family history / genetics
- Race or ethnicity: People of African American, Hispanic, Asian, or Native American descent
- High blood pressure
- History of acute kidney injury
- Diabetes diagnosis
- Obesity
- Autoimmune disorders
- Heart disease
- Smoking or tobacco use
Non-alcoholic Fatty Liver Disease
- Family history / genetics
- Viral hepatitis
- History: IV drug use with shared needles
- History: High risk behaviors such as unprotected exposure to hepatitis viruses and chemical toxins
- Type 2 Diabetes
- Obesity
- High cholesterol
- High alcohol use
While these conditions all have risk factors and many of these risk factors are shared across multiple chronic illnesses: Family history and genetics, diabetes, obesity, cholesterol levels, inactivity, smoking, and elevated blood pressure. You don’t choose your parents, so don’t focus on your genetics, but you can affect diabetes, obesity, blood pressure, inactivity, smoking, and cholesterol levels.
The reversal begins with a single step
When you look at the risk factors you can change, a number of options present themselves:
Smoking and tobacco use
I’m not saying cessation of tobacco use is easy, it may be a good place to start. For medications to support smoking cessation, check with your healthcare provider or third-party payer/insurance. There are also programs to increase your success:
- National Quitline: Call 1-800-QUIT-NOW (1-800-784-8669) Free, confidential coaching, a customized quit plan, and potential free supplies of nicotine replacement therapy depending on eligibility.
- Smokefree.gov: A federal website offering free text support programs (SmokefreeTXT), the quitSTART app, and quit plan builders.
- Freedom From Smoking: American Lung Association’s structured smoking cessation program. https://www.lung.org/quit-smoking/join-freedom-from-smoking
- Empowered to Quit: American Cancer Society’s smoking cessation program. https://www.cancer.org/cancer/risk-prevention/tobacco/empowered-to-quit.html
Weight loss
The path to successful weight loss is supported by medications, insurance companies, online resources, and cell phone apps. Weight loss can be difficult without resources that understand the challenges, e.g., food noise. Additionally, weight loss incorporates other risk factors along the way, e.g., decreasing physical inactivity plus nutrition support for healthier food options and recipes (that are heart healthy and carbohydrate controlled). Additionally, even modest weight loss is associated with improved health indicators across the board.
You can affect all your tomorrows with a few better choices today. Commitment to the journey is your first step. Know who drives your health. You hold the wheel to decide the journey. When you leave your home today, know it is the first step in your journey to live healthier.