Introduction
Cardiovascular events are caused mainly by elevated cardiometabolic risk (CMR). Due to the high incidence of CMR causes, primary care must provide quick assessment and appropriate treatment to prevent further complications. Most people with CMR are best discovered during regular screening because they have no known diseases. CMR is addressed by disease prevention efforts that are targeted through health promotion. Family doctors and primary care teams should then provide counseling on behavior modification, and where possible, they should refer patients to qualified dieticians and exercise specialists (kinesiologists). Vascular preventative treatments, including medication and bariatric surgery for weight loss, may be advised for high-risk people. By successfully treating the root causes of these conditions, this strategy systematizes preventing diabetes and vascular disease in primary care.
What Is Primary Care?
Primary care is a paradigm of care that emphasizes first-contact, accessible, ongoing, comprehensive, and coordinated individual-focused care, according to the World Health Organization. Ensuring that subgroups have equitable access to services seeks to improve population health and decrease inequities within the population. A health system offering promotional, protective, preventative, curative, rehabilitative, and palliative treatments throughout life relies heavily on primary care. Primary health care (PHC) is a more comprehensive, society-wide strategy that consists of three parts:
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Primary care and essential public health are the core of integrated health services.
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Multisectoral policy and action.
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Empowered people and communities.
What Are Cardiometabolic Risk Factors?
Age, sex, family history, hypertension, dysglycemia, dyslipidemia, and smoking are recognized classic cardiovascular disease risk factors. Inflammation, as evaluated by high-sensitivity C-reactive protein (hs-CRP) levels, abdominal obesity (measured by waist circumference), insulin resistance, lack of fruit and vegetable consumption, sedentary lifestyle, and psychosocial stress, are some of the more recently studied cardiovascular risk factors. In addition, for risk assessment and CMR therapy in individuals with increased triglyceride levels, an apolipoprotein B test can take the role of low-density lipoprotein cholesterol.
The INTERHEART research evaluated 27 000 participants from 52 countries and identified nine risk factors in myocardial infarction patients, including abnormal lipids, smoking, hypertension, diabetes, abdominal obesity, psychosocial stress, a lack of fruits and vegetables, a lack of moderate alcohol consumption, and a lack of physical activity, that together accounted for 90 % of the population-attributable risk of myocardial infarction in men and 94% in women. This study demonstrated the significance of established and newly discovered risk factors, including abdominal obesity, psychological stress, food, and inactivity, and the necessity to motivate the general public, particularly patients at high risk, to adopt adjustments to lower these risk factors.
What Are Cardiometabolic Risk Reduction Strategies?
1. Screening - Nurses in primary care frequently perform the first screening for cardiometabolic diseases and their associated risks. Nurses or other qualified professionals can take regular weight, height, and blood pressure measures. They can also make simple inquiries regarding smoking, drinking, and any family members with cardiovascular disease (CVD) or type 2 diabetes mellitus.
Blood tests for non-fasting lipids, liver biochemistry, and kidney function are recommended for people at risk for CVD. Analyses of glycated hemoglobin (HbA1c; a test of average blood sugar over the previous two to three months) or fasting glucose, if patients have fasted, are simple additions for individuals at risk of diabetes.
A wide range of conditions, including those linked to a higher risk of CVD (such as hypertension, rheumatoid arthritis, systemic lupus erythematosus, erectile dysfunction, and severe mental illness), should be simple to check whether patients have had recent such tests in primary care.
2. Diet - Screening may be coupled with dietary advice as significant weight loss might almost instantly result in a drop in HbA1c, other CMR factors, or even the reversal of diabetes. In contrast, weight loss or lifestyle improvements may take years to demonstrate positive effects on CVD outcomes. With that said clinicians must not lose sight of the impact of even modest weight changes on the quality of life, mental health, and self-esteem.
3. Physical Activity - According to a study, performing just 6 minutes per day of moderate to vigorous physical activity was linked to a 30 % lower mortality risk. There is strong evidence that increased physical activity is linked to better health outcomes, with greater exercise being preferable. Any increase in activity is helpful. Combining little physical exercise throughout the day or incorporating active transport are effective ways to fit in physical activity and reap the rewards. There is growing evidence that smartphone-based approaches can effectively promote physical activity. Pedometers support these approaches and include the setting of progressive physical activity goals, self-monitoring, and feedback on activity levels. However, goals must be specific to the individual and realistic. For instance, for someone who is extremely passive, increasing their step count by 1,000 per day at first, roughly equivalent to an additional 10 minutes of walking, may be beneficial and set the stage for future increases in activity.
How Can Cardiometabolic Risk Reduction and Management Be Inculcated in Primary Care?
1. Risk Reduction: Regular Exercise and Lifestyle Changes:
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The main course of action for increased CMR is a lifestyle change. This involves concurrent counseling on exercise, calorie consumption, food composition, and quitting smoking. Regular exercise (three to five days a week for 30 to 60 minutes each day) is the first step in therapy.
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Regular, moderate-intensity exercise has been linked to favorable decreases in waist circumference, weight, and visceral fat. For obese people, calorie restriction consistently results in a drop in waist circumference. Exercise and calorie restriction both improve insulin resistance. Exercise effectively lowers blood pressure, although calorie restriction has a small and insignificant impact. However, even little blood pressure drops reduce the risk to the individual's health.
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Before considering further medication in any patient, lifestyle changes should be pursued for 3 to 6 months unless the patient is at high risk. Even after starting medication, it is crucial to emphasize to the patient the value of ongoing health behavior modification.
2. Management
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Cardiovascular Diseases: The following is a detailed treatment plan for people with elevated CMR. The healthcare provider may advise starting statin treatment in individuals who are at high risk (greater than 20% CVD risk over the next 10 years) concurrently with the beginning of behavioral changes. The objective is to reach either the target LDL-C level ( 2.0 mmol/L or a 50 % reduction in the present LDL-C level) or an apolipoprotein B level of 0.8 g/L.
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Prediabetes: Weight reduction and increased physical activity are the favored methods for avoiding or delaying the onset of diabetes in people with prediabetes (impaired fasting glucose or impaired glucose tolerance). However, medication is also an option. When three to six months of behavior adjustment have not yielded the expected results for individuals with prediabetes or diabetes, metformin is the drug of choice.
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Obesity: With an acceptable operational risk, bariatric surgery may be considered for extreme obesity with inadequate weight reduction despite behavioral or pharmacologic therapy. In addition to enhancing the quality of life and reversing aberrant glucose metabolism, including diabetes, bariatric surgery has been proven to reduce all-cause mortality by 24 % to 40 %. However, late problems from dietary inadequacies and behavioral abnormalities may develop.
Conclusion
The medical community must create better management protocols to address this problem, which significantly influences patients' quality of life and potential for illness. The key message is that the medical community in primary care must adopt a more sympathetic and supportive stance toward obesity so that patients will be inspired to attempt to improve their lives and better understand how to do so, thereby reducing the cardiometabolic risk. Better methods are also required to communicate hazards to the general public in a way that motivates individuals to adopt healthier lifestyles, and it's time to step up preventative efforts with a more sympathetic and beneficial emphasis on lifestyle.
