Cardiometabolic Risk

Overview

Cardiometabolic risk refers to the combined risk of developing cardiovascular disease and metabolic disorders, most commonly type 2 diabetes mellitus, hypertension, dyslipidemia, chronic kidney disease, and metabolic liver disease. It arises from a cluster of interrelated metabolic abnormalities, including insulin resistance, central obesity, abnormal lipid metabolism, and chronic low-grade inflammation [1,2].

Globally and in Pakistan, cardiometabolic risk has increased sharply due to rising rates of obesity, sedentary lifestyles, and poor dietary patterns. National data show Pakistan has one of the highest burdens of diabetes and obesity, placing a large proportion of the adult population at elevated cardiometabolic risk [1,3].

Cardiometabolic risk is now recognized as a continuum, where early metabolic dysfunction progressively leads to organ damage, cardiovascular events, and premature mortality if not addressed in time [2,4].

Causes

Cardiometabolic risk develops through a complex interaction of metabolic, behavioral, and biological factors rather than a single disease process.

Key contributors include:

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	Central (abdominal) obesity, which promotes insulin resistance and inflammation
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	Insulin resistance and impaired glucose metabolism
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	Dyslipidemia, including elevated triglycerides and low HDL cholesterol
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	Hypertension, driven by vascular and renal dysfunction
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	Sedentary lifestyle and low physical activity
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	Unhealthy dietary patterns, particularly high refined carbohydrate and fat intake
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	Genetic predisposition influencing metabolic regulation
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	Chronic inflammation and adipose tissue dysfunction
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</ul>

These factors interact to create a self-reinforcing cycle of metabolic deterioration, often referred to as cardiometabolic syndrome [2,5].

Signs & Symptoms

Cardiometabolic risk often develops silently and may remain asymptomatic for years. When present, symptoms are usually related to underlying metabolic abnormalities or emerging complications.

Common features may include:

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	Central weight gain and increasing waist circumference
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	Persistent fatigue and reduced exercise tolerance
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	Elevated blood pressure readings
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	Increased thirst or frequent urination
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	Shortness of breath with exertion
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	Sleep disturbances, including snoring or daytime sleepiness
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	Reduced physical stamina
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</ul>

In many individuals, cardiometabolic risk is first identified through laboratory testing rather than symptoms. Uncontrolled cardiometabolic risk significantly increases the likelihood of major adverse cardiovascular and metabolic outcomes.

Key complications include:

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	Type 2 diabetes mellitus
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	Atherosclerotic cardiovascular disease, including heart attack and stroke
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	Heart failure, particularly heart failure with preserved ejection fraction (HFpEF)
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	Chronic kidney disease and progressive renal decline
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	Metabolic dysfunction&ndash;associated steatotic liver disease (MASLD/MASH)
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	Obstructive sleep apnea
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	Increased all-cause and cardiovascular mortality
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</ul>

Evidence shows that cardiometabolic risk factors are interlinked, meaning progression in one domain accelerates damage in others [2,4,6].

Diagnosis

Assessment of cardiometabolic risk requires a multidimensional clinical evaluation rather than reliance on a single marker.

Evaluation may include:

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	Measurement of body mass index (BMI) and waist circumference
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	Blood pressure assessment
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	Fasting and post-prandial blood glucose and HbA1c
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	Lipid profile, including triglycerides and HDL cholesterol
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	Renal function tests, including eGFR and albuminuria
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	Liver enzymes to assess metabolic liver disease
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	Assessment of personal and family history of cardiovascular disease or diabetes
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</ul>

Clinical frameworks emphasize identifying cardiometabolic risk early, even before overt diabetes or cardiovascular disease develops [4,7].

Management

Management of cardiometabolic risk focuses on reducing long-term cardiovascular and metabolic complications, rather than treating individual risk factors in isolation.

Current evidence-based approaches include:

<h4>Lifestyle and Behavioral Interventions</h4>

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	Balanced, calorie-appropriate nutrition
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	Regular physical activity suited to individual capacity
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	Weight and waist-circumference reduction
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	Sleep optimization and stress management
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</ul>

<h4>Medical and Structured Care Approaches</h4>

Clinical guidelines recognize that lifestyle measures alone may be insufficient for many high-risk individuals. Management should be guided by overall cardiometabolic risk burden, rather than glucose or weight levels alone [4,7].

Medical strategies may be considered in individuals with:

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	Established cardiometabolic disease
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	Multiple coexisting risk factors (obesity, diabetes, hypertension, dyslipidemia)
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	Evidence of organ involvement (heart, kidney, liver)
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</ul>

<h4>Integrated, Risk-Based Management</h4>

Modern cardiometabolic care emphasizes integrated risk reduction, targeting glucose control, weight, blood pressure, and lipid abnormalities simultaneously to reduce cardiovascular and renal events [2,6].

Early, comprehensive intervention significantly improves long-term outcomes.

Conclusion

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	Cardiometabolic risk reflects interconnected metabolic and cardiovascular dysfunction
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	Central obesity and insulin resistance are key drivers
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	Risk often develops silently before clinical disease appears
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	Early identification allows prevention of diabetes, heart disease, and organ damage
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	Integrated, long-term management is essential for reducing morbidity and mortality
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</ul>

<h3>References</h3>

<ol>
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	International Diabetes Federation. (2024). IDF country profile: Pakistan. International Diabetes Federation. <a href="https://idf.org/our-network/regions-and-members/middle-east-and-north-africa/members/pakistan/" rel="noopener" target="_new">https://idf.org/our-network/regions-and-members/middle-east-and-north-africa/members/pakistan/</a>
	</li>
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	Arragan Lezama, C. A., et al. (2025). Cardiovascular&ndash;renal&ndash;hepatic&ndash;metabolic syndrome: Interlinked pathophysiology and integrated management approach. Cureus, 17(1), https://pubmed.ncbi.nlm.nih.gov/40662045/&nbsp;
	</li>
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	World Obesity Federation. (2025). World Obesity Atlas 2025. World Obesity Federation. <a href="https://www.worldobesity.org/resources/resource-library/world-obesity-atlas-2025?utm_source=chatgpt.com" rel="noopener" target="_new">https://www.worldobesity.org/resources/resource-library/world-obesity-atlas-2025</a>
	</li>
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	American Diabetes Association. (2025). Standards of care in diabetes&mdash;2025. American Diabetes Association. <a href="https://professional.diabetes.org/standards-of-care" rel="noopener" target="_new">https://professional.diabetes.org/standards-of-care</a>
	</li>
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	Busetto, L., Dicker, D., Fr&uuml;hbeck, G., Halford, J. C. G., Sbraccia, P., Yumuk, V., &amp; Goossens, G. H. (2024). A new framework for the diagnosis, staging and management of obesity in adults. Nature Medicine, 30, 2395&ndash;2406. https://pubmed.ncbi.nlm.nih.gov/38969880/&nbsp;
	</li>
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	Marso, S. P., Daniels, G. H., Brown-Frandsen, K., Kristensen, P., Mann, J. F. E., Nauck, M. A., &hellip; Buse, J. B. (2016). Liraglutide and cardiovascular outcomes in type 2 diabetes. New England Journal of Medicine, 375(4), 311&ndash;322. https://doi.org/10.1056/NEJMoa1603827
	</li>
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	American Association of Clinical Endocrinology. (2025). American Association of Clinical Endocrinology consensus statement: Algorithm for the evaluation and treatment of adults with obesity/adiposity-based chronic disease&mdash;2025 update. Endocrine Practice. <a href="https://www.endocrinepractice.org/article/S1530-891X(25)00977-2/fulltext" rel="noopener" target="_new">https://www.endocrinepractice.org/article/S1530-891X(25)00977-2/fulltext</a>
	</li>
</ol>

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