Dr. Saxena on Cardiometabolic Risk Factors

Assessing cardiometabolic risks has evolved over time. Simultaneously, primary care is still the proposed central hub for evaluating cardiometabolic risks and intervening.1-3 In the video below, Shilpa P. Saxena, MD, IFMCP, an IFM educator, explains the shift in her thinking for addressing cardiometabolic risk in her patients since medical school.


If you’re like me, you were trained to think that when you do a standard lipid panel, a standard cholesterol panel, you’ve done your job in terms of assessing risk for a patient who might have cardiovascular risk factors. So you check your cholesterol, and you think, “Oh, their total cholesterol seems to be under 200.” Their HDL cholesterol looks to be, you know, maybe above 60. You look at their LDL cholesterol, and it seems to be in the range that’s okay for that person at that age with their risk factors.

The truth is that 50% of people with heart attacks have “normal” cholesterol.

And why this is problematic is it means that [for] one out of every two people having a heart attack, we haven’t addressed the risk factors that caused their heart attack. And so what we’ve come to understand and what research is showing is that cholesterol, although helpful, is not the full answer—that we need to take a global approach. And a global approach means digging beyond LDL cholesterol, maybe looking at LDL particle number. We also need to look at metabolic disturbances. Insulin and blood sugar drive heart disease just as much, if not more in some populations, than just LDL-focused issues.

And so we’re really excited to be able to expand your lens, widen that lens, to go beyond LDL cholesterol and smoking and weight and go on to broader concepts of prevention and strategy so that we’re not waiting for your patient to become just a bundle of risk factors, waiting for an event to occur. We want to identify the things that precede those risk factors, address them with actionable lifestyle change, so that we can change the course of that patient’s timeline.

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  1. Chatterjee A, Harris SB, Leiter LA, et al. Managing cardiometabolic risk in primary care: summary of the 2011 consensus statement. Can Fam Physician. 2012;58(4):389-393, e196-e201.
  2. Engelsen Cd, Koekkoek PS, Godefrooij MB, Spigt MG, Rutten GE. Screening for increased cardiometabolic risk in primary care: a systematic review. Br J Gen Pract. 2014;64(627):e616-e626. doi:3399/bjgp14X681781
  3. de Waard AM, Wändell PE, Holzmann MJ, et al. Barriers and facilitators to participation in a health check for cardiometabolic diseases in primary care: a systematic review. Eur J Prev Cardiol. 2018;25(12):1326-1340. doi:1177/2047487318780751

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