Published in Journal of American College of Cardiology Only 6.8% of Americans have been shown to be in optimal cardiac metabolic health. As a family nurse practicing lifestyle medicine, I am very worried that the other 93.2% of Americans are not in optimal cardiac metabolic health.
Our health care system also needs to be worried. As a performance improvement nurse in 2013, I was first introduced to the concept of value-based care and an accountable care organization. In 2022, we will gradually move away from service fees, but improving the health of cardiac metabolism will be an important factor in improving the health of the population.
What is optimal cardiac metabolic health?
So what exactly is cardiac metabolic health and what is best? That’s a good question. Optimal cardiovascular health is the absence of a range of disorders that increase the risk of heart disease and type 2 diabetes. These include high blood pressure, high fasting blood sugar, abnormal cholesterol levels, excess abdominal weight, and high triglycerides.
The journal study was based on the results of the National Health and Nutrition Examination Survey. Risk factors for cardiovascular metabolism analyzed in this study included body weight, blood glucose, cholesterol, blood pressure, and clinical cardiovascular disease. Studies show that changes in mean body weight and blood glucose levels were the two most influential factors in reducing the health of the population’s cardiac metabolism between 1999 and 2018. Optimal weight was considered a body mass index (BMI) of less than 25. Waist circumference is 88 cm or less for women and 102 cm or less for men. Optimal blood glucose criteria included the need for no diabetes medication, fasting blood glucose below 100 mg / dL, and hemoglobin A1C below 5.7%. Low body weight levels were considered to have a BMI greater than 30 and waist circumference greater than the cutoff measurements above. The decrease in blood glucose was at fasting levels of 126 mg / dL or higher, or hemoglobin A1C of 6.5% or higher.
Approaches to Improve Cardiac Metabolic Health
Nine of the top ten leading causes of death in the United States have obesity and overweight as risk factors. These include heart disease, certain cancers, COVID-19, stroke, chronic lower respiratory tract disease, Alzheimer’s disease, diabetes, influenza, and nephrotic syndrome. Heart disease alone costs hundreds of billions of dollars each year between treatment, medication, and loss of wages due to death. In fact, 90% of US medical costs are related to chronic illness and mental health.
The good news for 73.6% of US adults who are considered overweight or obese and many of whom are not in optimal cardiac metabolic health is FDA-approved weight loss medications that help compensate for dietary and lifestyle changes. That is. Alone, it is unsustainable or ineffective in improving a variety of health conditions.
Bad news? The coverage of these medicines depends on the state, type of insurance, and employer’s plans. These medicines are usually not covered by Medicaid or Medicare, including where I am practicing in Illinois. Weight loss medications are often uncovered, even for patients with employer-based commercial plans.
I had the opportunity to witness the power of lifestyle change, coupled with access to medicines to help patients reach their health goals. For example, one patient who was diagnosed with diabetes 11 years ago had difficulty managing diabetes and losing weight. We work together for 6 months, mainly increasing fluid intake, reducing sodium intake, adding vegetables to our daily diet, going to the gym 4-5 times a week, reducing carbohydrate intake , Made lifestyle adjustments such as adding protein. And healthy fat in her diet. He also introduced her to an endocrinologist to optimize her medications, including weight gain-related diabetes reductions, and include GLP-1 agonists, a class of weight-loss-related diabetes medications. Did.
These lifestyle changes and drug adjustments have helped her achieve her health goals. In six months she was able to lose 25 pounds and 6.7 inches (17 cm) from her waist circumference. Her hemoglobin A1C dropped to 5.6%, below her prediabetes diagnostic level. She has become better able to manage diabetes than in her last 11 years. She felt so good that she shed joyful tears in my office. She thanked me, but I told her she was the one who made all the efforts.
Unfortunately, this is a success story that not everyone can experience.
For this particular patient, the GLP-1 receptor agonist was covered by the insurance company as it is indicated for the treatment of type 2 diabetes. However, there are other GLP-1 receptor agonists, such as liraglutide (Saxenda) and semaglutide (Wegovy). These are FDA-approved, but are often not covered by insurance because their specific use is for weight loss.
This is just one example of how our healthcare system is responsive rather than prophylactic. Obesity has been recognized as a chronic disease by the American Medical Association since 2013. Treatment of obesity should be initiated by providing appropriate drug coverage and increasing the availability of a comprehensive program of lifestyle-related medicine, behavioral health, and preventive cardiology. Indeed, primary prevention of obesity and pathological obesity is optimal, and initiatives aimed at it should also be prioritized.
Obesity is a complex chronic disease with roots in metabolic dysfunction, a social determinant of health, socioeconomic status, access to health foods, grants to corn and sugar companies, convenience of fast food, It is affected by stress, genetics, etc. In many cases, it’s not as simple as “eating less and getting more exercise.” There, medication can provide additional support.
There are safe and effective medicines that have been approved by the FDA for weight loss and have been rigorously tested prior to approval. Access to these medicines needs to be increased by providing universal health insurance.
Elizabeth Simx, DNP, FNP-C is a family nurse practicing lifestyle medicine at the Rush University Medical Center, an instructor in the Community, Systems and Mental Health Nursing Department of the Rush University School of Nursing, and the OpEd Project. ..
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