Even with the tremendous resources devoted to cardiovascular disease assessment and management over the past 60 years, it remains the most prevalent disorder in the United States today. Notable advances have been made in the assessment and treatment of heart disease, stroke, and peripheral vascular disease; however, there are still significant gaps in our knowledge of the underlying causal mechanisms and what to do about both prevention and treatment.
During the past decade, convincing evidence has accumulated that conquering heart disease is not simply a matter of driving serum cholesterol to lower and lower levels; in fact, half the people who have a heart attack have normal cholesterol. Newer research has thrown into question the primacy of elevated LDL cholesterol as the primary driver of heart disease. It appears that cholesterol, while an important signpost, is but one of a variety of markers that indicate cardiovascular risk. “Distinguishing between risk factors and causes is necessary for effective primary prevention and treatment of chronic disease…. Risk factor treatment must be replaced with elimination of the drivers, triggers, and causes of chronic disease.”
The new era mentioned in the conference title reflects heart disease as a multifactorial condition that demands a multifactorial systems biology approach. A new term, cardiometabolic syndrome, has emerged to suggest that there is a broader net we can cast to more effectively understand and treat the many interconnected complex conditions encompassed by the term cardiovascular and metabolic dysfunction. A variety of cardiometabolic risk (CMR) factors combine and interact in a multidirectional web of influences that disturb metabolic function; these disturbances, if left untreated, may become diagnosable ICD-9 diseases that include not only heart disease, but diabetes, hypertension, stroke, congestive heart disease, peripheral vascular disease, nonalcoholic steatohepatitis (NASH), kidney disease, infertility, polycystic ovarian syndrome (PCOS), breast cancer, and sleep apnea.
The evidence linking cardiovascular disease (CVD) and metabolic syndrome is now very strong. Not only do patients with metabolic syndrome experience higher rates of CVD than controls without metabolic syndrome, but the presence of metabolic syndrome makes treatment (and prevention) of CVD more difficult and less successful.
Because heart disease remains the #1 killer in the U.S. and many other countries, an enormous amount of research is published, leading physicians to struggle with many complex issues. Some critical questions that will shape the content of this conference to meet the needs of practicing clinicians include:
- How do clinicians know which risk factors and biomarkers to emphasize in patient assessment?
- What is an effective approach to individualizing patient assessment according to each person’s unique set of risks and dysfunctions?
- What are the real side effects and risks of statin therapy?
- How big a part does diet play in cardionmetabolic risk?
- How can we prevent the oxidation of cholesterol that appears to significantly increase cardiovascular risk?
It is now well understood that the heart is not just a pump, but is also an organ with neurological, endocrine, and immune actions and effects. In the systems biology of health and disease, it is both affected by, and affects, general metabolic function. While we should investigate the physiological domain, we must also remember that healing the heart requires treating the whole person. The mental, spiritual, and emotional aspects of healing cannot be separated from the physical. The ability to move into a patient-centered therapeutic relationship allows for true healing. Therefore we will infuse discussions of body-mind-emotional-spiritual healing into various interactive opportunities at the conference.