Risk Factors Analysis and Management of Cardiometabolic-Based Chronic Disease in Low- and Middle-Income Countries

Abstract

The epidemic of obesity or adiposity-based chronic diseases presents a significant challenge with the rising prevalence of morbidities and mortality due to atherosclerotic cardiovascular diseases (ASCVD), especially in low- and middle-income countries (LMIC). The underlying pathophysiology of metabolic inflexibility is a common thread linking insulin resistance to cardiometabolic-based chronic disease (CMBCD), including dysglycemia, hypertension, and dyslipidemia progressing to downstream ASCVD events. The complex CMBCD paradigm in the LMIC population within the socio-economic and cultural context highlights considerable heterogeneity of disease predisposition, clinical patterns, and socio-medical needs. This review intends to summarize the current knowledge of CMBCD. We describe recently established or emerging trends for managing risk factors, assessment tools for evaluating ASCVD risk, and various pharmacological and non-pharmacological measures particularly relevant for LMICs. A CMBCD model positions insulin resistance and β-cell dysfunction at the summit of the disease spectrum may improve outcomes at a lower cost in LMICs. Despite identifying multiple pathophysiologic disturbances constituting CMBCD, a large percentage of the patient at risk for ASCVD remains undefined. Targeting dysglycemia, dyslipidemia, and hypertension using antihypertensive, statins, anti-glycemic, and antiplatelet agents has reduced the incidence of ASCVD. Thus, primordial prevention targeting pathophysiological changes that cause abnormalities in adiposity and primary prevention by detecting and managing risk factors remains the foundation for CMBCD management. Therefore, targeting pathways that address mitochondrial dysfunction would exert a beneficial effect on metabolic inflexibility that may potentially correct insulin resistance, β cell dysfunction and, consequently, would be therapeutically effective across the entire continuum of CMBCD.

Keywords:

• mitochondrial modulator
• insulin resistance
• diabetes mellitus
• dyslipidemia hypertension
• non-high-density lipoprotein-cholesterol
• triglycerides
• apolipoprotein B

Acknowledgments

The authors received no direct compensation related to the development of the manuscript. Writing and editorial support was provided by Dr Suchit Kumbhare and Dr Deepa Joshi.

Disclosure

Dr Chaitanya Dutt is an employee of Torrent Pharmaceuticals Ltd. Prof. Dr Joao Eduardo Nunes Salles reports personal fees from AstraZeneca, Novo Nordisk, Eli Lilly, MSD, Boehringer Ingelheim, and Bayer, during the conduct of the study. Dr Shashank Joshi reports speaker fees from Torrent, during the conduct of the study; speaker fees from Eli Lilly, Abbott, Boehringer Ingelheim, Astra Zeneca, MSD, and PHFI; advisory for/from Sanofi, Franco India, Marico, Bayer Zydus, Roche Diabetes Care, Twin Health, and Zydus Cadila; speaker fees and advisory for/from Novo Nordisk, outside the submitted work. Professor Subhankar Chowdhury reports advisory board member for Glenmark, outside the submitted work. The authors report no other potential conflicts of interest in this work.