Cardiometabolic-Based Chronic Disease, Adiposity and Dysglycemia Drivers: JACC State-of-the-Art Review

Jeffrey I. Mechanick, Michael E. Farkouh, Jonathan D. Newman, W. Timothy Garvey

Research output: Contribution to journalReview articlepeer-review

66 Scopus citations


A new cardiometabolic-based chronic disease (CMBCD) model is presented that provides a basis for early and sustainable, evidence-based therapeutic targeting to promote cardiometabolic health and mitigate the development and ravages of cardiovascular disease. In the first part of this JACC State-of-the-Art Review, a framework is presented for CMBCD, focusing on 3 primary drivers (genetics, environment, and behavior) and 2 metabolic drivers (adiposity and dysglycemia) with applications to 3 cardiovascular endpoints (coronary heart disease, heart failure, and atrial fibrillation). Specific mechanistic pathways are presented configuring early primary drivers with subsequent adiposity, insulin resistance, β-cell dysfunction, and metabolic syndrome, leading to cardiovascular disease. The context for building this CMBCD model is to expose actionable targets for prevention to achieve optimal cardiovascular outcomes. The tactical implementation of this CMBCD model is the subject of second part of this JACC State-of-the-Art Review.

Original languageEnglish
Pages (from-to)525-538
Number of pages14
JournalJournal of the American College of Cardiology
Issue number5
StatePublished - 11 Feb 2020


  • adipokines
  • adiposity
  • atherosclerosis
  • atrial fibrillation
  • cardiomyopathy
  • cardiovascular
  • chronic disease
  • dysglycemia
  • insulin resistance
  • obesity
  • type 2 diabetes


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