Letter from the SELA President: Reducing Cardiometabolic Disease in a Multifaceted, Kaleidoscopic Way

“Rust Never Sleeps” – Neil Young

“A man (woman) is only as old as his (her) arteries”- Sir William Osler

We know that cardiometabolic disease is foundational for many chronic illnesses - atherosclerosis, diabetes, dyslipidemia, stroke, hypertension, even cancer and late onset Alzheimer’s dementia. The majority of ASCVD events are driven not only by high LDL, but by the atherogenic triad of elevated apoB, triglyceride-rich remnant particles, and dysfunctional HDL, a triad led by insulin resistance. Cardiometabolic disease is often fueled by overweight and obesity (now 70% of Americans) as a result of poor lifestyle choices, e.g., excessive carbohydrate consumption (especially fructose), lack of exercise, and insufficient sleep. The “rust” builds from childhood and “ages” our arteries.

In this issue of LipidSpin we address this pandemic of cardiometabolic disease, including a careful look at insulin resistance as one of the drivers. As noted in the theme of this edition, it is indeed a kaleidoscope! Topics include the relationship between cardiometabolic disease and obesity, the importance of team-based care, lifestyle management as an anchoring factor including both dietary approaches and exercise, as well as pharmacologic strategies, and the foundational concept of primordial prevention.

I very feel honored by my election as SELA President and hope to focus on insulin resistance and cardiometabolic disease during this year. I also have two additional goals:

• Helping clinicians to do a better job of diagnosing and slowing the progression of fatty liver/NASH/NAFLD; and
• Motivating our patients to incorporate resistance training into their regular exercise regimens. How many of our patients walk at least a bit, yet never implement a resistance training strategy, out of either fear or lack of knowledge?

Lastly, as the original founding subchapter of the NLA, I want to recognize my SELA mentors and predecessors, such as Roger Blumenthal, Peter Kwiterovich, Dean Bramlett, Bill Cromwell (and non-SELA member Tom Dayspring), who inspired me to progress from a good internist to a great Clinical Lipidologist. I want to thank all the SELA contributors who worked so hard to make this a great issue. Thanks also to Dr. Mintz and the NELA contributors of this LipidSpin issue.

It’s time for all of us to get out there and STOP the rust and slow down the aging of our arteries!