Cardiometabolic risk reduction at population level: a utopia or a challenge?

Disease (GBD) database, Li et al. highlighted a complex trend: while there are improvements in blood pressure management across populations, there is a troubling rise in the incidence of type 2 diabetes and obesity globally, particularly pronounced in developing countries. Their projections suggest that the detrimental effects of metabolic risk factors will surpass the cardiovascular benefits derived from enhanced hypertension control, in terms of leading to higher cardiovascular mortality rates. This analysis assessed metabolic risk based on traditional markers like body mass index, fasting plasma glucose, and low-density lipoprotein (LDL)-cholesterol levels. Yet, it is important to acknowledge that cardiometabolic risk extends beyond these factors to include insulin resistance, non-high density lipoprotein (HDL) cholesterol or apolipoprotein B-containing lipoproteins, Lp(a), serum uric acid, and metabolic dysfunction-associated steatotic liver disease (MASLD).