Letter from the NELA President: Cardiometabolic Disease: Collaboration is the Key

Atherosclerosis is a progressive disease that affects us throughout our lifetime. Although we know a lot about its process, much more needs to be elucidated. One of my professors said, “the best statin in the world will only reduce cardiovascular events by 50%; our challenge is what causes the other 50% of clinical events.” Today, we are at the precipice of forging an answer to this challenge—it is not solely about cholesterol. Inflammation clearly plays a role in atherosclerotic progression, diabetes is so much more than blood sugar, and cardiometabolic disease is truly a kaleidoscope of cardiovascular peril.

This edition of the LipidSpin is an invitation to look at our patients holistically and critically to identify opportunities to thwart the atherosclerotic process. It features an overview of cardiometabolic disease and therapeutic choices, the effects of metabolic syndrome and insulin resistance, how diabetes, obesity, and other characteristics lead to cardiovascular disease, and the relationship between liver steatosis and non-alcoholic liver disease. Clinicians will also appreciate the insights into the role of aspirin in 2022. In addition, our role as clinicians includes helping our patients achieve lifestyle and dietary changes. Our patients need to get moving and we need to move faster to help them realize that they can help themselves. We need to motivate our patients and peers. It takes a village, and we have the knowledge and the resources to take on this challenge and succeed.  I hope that you will use this issue as a reference when treating your cardiometabolic patients.

Our mission starts with the recognition of overall cardiovascular risk which extends beyond the cholesterol window. We are well on our way to mastering the lipid side of the equation, including Lp(a). We need to understand the role of risk enhancing features such as metabolic syndrome, chronic kidney disease, the role of inflammatory disease states such as rheumatoid arthritis and psoriasis, early menopause, and pre-eclampsia. As primary care physicians, cardiologists, endocrinologists, and advanced practice professionals, we need to come together, take off our blinders, and step out of our lanes. I invite all of you to cross the lines, leave your comfort zones and recognize the kaleidoscope of cardiometabolic effects as they blend together to perpetuate atherosclerotic disease.

It has been my pleasure to work with such an enthusiastic and talented NELA membership, who if they had their way, this LipidSpin would be a book—everyone wanted to contribute. This enthusiasm is truly the magic of the NLA, a selfless group of clinicians committed to uplifting others, contributing to their education and career development, while positively affecting the lives of our patients. Everyone has so much to give. I would like to thank Dr. Greg Pokrywka and SELA for their outstanding contributions to this edition and the comradery and collegiality in our collaborative working relationship.

It is an honor to serve as NELA president. I am always available to our NELA family, and I look forward to meeting and working with all of you in the next year. Tell me how I can help you. My goal this year is to enhance the education of our membership and I am proud to announce NELA Nights, evenings of educational exchange with national experts. We will grow membership and engage our communities. In the words of the singer/songwriter Natasha Bedingfield, “The rest is still unwritten.” I challenge all of us to question, research, and solve the missing pieces of the cardiometabolic puzzle.  We are on the right path to sorting out this kaleidoscope. Consider this issue the beginning of our journey.