Cardiometabolic disorders constitute a mix of metabolic abnormalities ranging from insulin resistance, glucose intolerance, obesity, hypertension, dyslipidaemia, metabolic syndrome and Type 2 diabetes and full blown cardiovascular disease (CVD) – an eclectic mix not unlike rojak, the popular traditional fruit and vegetable salad dish commonly found in Indonesia, Malaysia and Singapore. Visceral fat is a key culprit in fuelling this mixed disorder. No longer regarded as mere inert storage depots, they are now recognised to be involved in highly regulated physiological pathways. Excess visceral fat causes disruption to these processes and brews trouble, like adding too much belacan (spicy shrimp paste) to your recipe. How fat is distributed and stored is highly variable between individuals. Just like ‘glocalizing’ the rojak, therapeutic strategies have to account for a spectrum of individuals ranging from the metabolically healthy obese African Americans to lean diabetic Asians.
Clinical trials and epidemiological studies show that managing risk factors using lifestyle modification, pharmacological and surgical modalities will ameliorate the progression of CVD. However, every strategy is fraught with its own challenges including poor patient adherence and an array of side effects. Therefore, the feasibility of these evolving management guidelines needs to be substantiated with evidence from observational studies. The latter provides us the much-needed kaleidoscopic view of naturally clustering comorbidities in the real world setting. In addition, we witness the true effectiveness, uptake and adherence to therapeutic strategies from a heterogeneous, unselected population. ERICAS provides a showcase of highly relevant observational studies with critical evaluation and comments from experts in the field -- a real world setting to taste test a recipe if you may, an important ingredient of success in this field.
Carolyn Lam is a Senior Consultant at the National Heart Centre, Singapore, and Professor of Duke-NHS Cardiovascular Academic Clinical Program
(Chanchal Chandramouli and Salma Asali also contributed to this blog)