Title : Metabolic dysfunction spilling over to the heart
Abstract:
Metabolic Dysfunction and Metabolic Syndrome birthed with visceral adiposity, and Insulin resistance has wide spread implications. From a bed of inflammation at the visceral adipose tissue core, RAAS activation and constricted vascular micro-perfusion. To hyperinsulinemia and volume expansion. Eventually, Insulin resistance at the brain level promoting compromised satiety, and yet a continuum of sympathetic stimulation at the brain level. Hypertension is an offspring of that, aggravated by a spiral of weight gain. Eventually, visceral adipocytes in defiance to insulin as resistance increases rebel with lipolysis, and showering the vascular endothelium, liver and myocardium with free fatty acids, toxic and arrhythmogenic. The background is already set with a longer QT interval triggered by Insulin resistance and hyperinsulinemia. The lipo-toxicity sets beta cells islets on fire, compromise their capacity and prediabetes or diabetes result. Livers are pushed to steatosis & MASLD. Endothelial cells to a dysfunctional status with No Nitric Oxide, i.e.No No. Eventually cardiac steatosis, Diastolic dysfunction, atherosclerosis and coronary endothelial compromise with first microcirculatory failure and HFpEF. Later in the course of the problem coronary atherosclerosis and HFrEF.Interventions to break the cycle can be critical in reversing this evil spiral. This explains why unexpectedly therapies directed at reversing insulin resistance, visceral adiposity reduced MACE, cardiac death, and all cause mortality. Something we did not encounter with sulphonyl - urea drugs nor insulin therapy apart from saving lives preventing ketoacidosis in insulin deficiency but not in insulin resistance which is much bigger problem and a wide spread pandemic. Supportive Cardiovascular outcomes from GLP1RA, SGLT2 inhibitors, SGLT1/T2 inhibitors, GLP1RA/GIP RA, and the future Dutides and Trutides.
Audience Take Away
- Mechanisms of cardiac compromise in the midst of the metabolic dysfunctional entangle
- How to use therapies that work synergistically to protect the cardiac performance while improving insulin resistance and reducing hyperinsulinemia
- How to avoid seemingly useful single directed therapies that may seem to help one area while compromising another angle of the metabolic dysfunction, e.g. Thiazide diuretics.
