The cardiometabolic clinic

An article written by Dr Edward Leatham, Consultant Cardiologist

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Introduction

Cardiovascular disease and metabolic disorders, including type 2 diabetes, continue to be leading causes of morbidity and mortality worldwide. Many of these conditions develop silently over years, often diagnosed only when complications arise. At SCVC, the cardiometabolic clinic plays a crucial role in early detection, prevention, and management of these diseases, using cutting-edge diagnostic tools and multidisciplinary care. This article explores the key benefits of the SCVC cardiometabolic clinic, illustrating its impact through real-world case assessments and the latest advancements in preventative medicine.

The Growing Need for Cardiometabolic Clinics

Similar to coronary heart disease, where symptoms often appear only after years of silent progression, type 2 diabetes is a condition that can be identified and managed long before formal diagnosis. Once diagnosed, the risks of developing cardiovascular conditions such as coronary artery disease and heart failure increase significantly. This necessitates a proactive approach in identifying risk factors and implementing preventive strategies.

SCVC’s cardiometabolic clinic caters to patients at various stages of metabolic and cardiovascular risk. It is designed not only to provide specialised care for individuals diagnosed with type 2 diabetes but also to identify patients who appear healthy but are on a trajectory towards metabolic disease. This proactive and preventive approach is critical to reducing the long-term burden of cardiovascular disease.

A Multidisciplinary Approach to Cardiometabolic Health

SCVC is uniquely positioned to offer specialised care through a dedicated team of experts, including:

• Diabetologists – Specialising in the management and treatment of diabetes.
• Cardiologists with expertise in cardiac imaging – Utilising advanced imaging techniques to assess coronary risk.
• Specialist nurses – Providing patient education, medication management, and lifestyle counselling.
• Nutritional therapists and dietitians – Offering guidance on dietary interventions to improve metabolic health.
• Exercise physiologists – Developing personalised fitness programmes to optimise cardiovascular and metabolic outcomes.
• Psychologists and psychotherapists – Addressing behavioural and emotional aspects of lifestyle change.

This collaborative approach ensures that every patient has the option to receive comprehensive, individualised care aimed at reducing cardiovascular risk and improving long-term health outcomes.

Cutting-Edge Diagnostic Tools for Early Detection

Over the last decade, SCVC has integrated state-of-the-art diagnostic technologies to assess and manage metabolic and lipid disorders that contribute to cardiovascular disease. Some of the key tools include:

1. Calcium Scoring and CT Angiography – These non-invasive imaging techniques allow for the early detection and quantification of coronary artery disease years before clinical events such as heart attacks occur.
2. Fat Attenuation Index (FAI) – A recent innovation from the Oxford Group and Caristo, this technology provides insights into active coronary inflammation, offering a clearer signal of patients at high risk of a first coronary event.
3. Comprehensive Metabolic Health Assessments – Including glucose tolerance tests, continuous glucose monitoring (CGM), lipid profiling, and pro-atherogenic proteins (such as LP  a ) analysis.

Case Study: The Impact of Early Detection

A 64-year-old male presented at the cardiometabolic clinic for assessment. He had a prior transient ischaemic attack (TIA) and elevated LDL cholesterol, which was being treated with statins. Despite being a non-smoker with normal blood pressure, his strong family history of myocardial infarction and strokes prompted further investigation.

Key Findings:

• Cardiac CT assessment revealed extensive non-obstructive coronary artery disease.
• Calcium scoring indicated significant coronary calcification.
• CaRi Heart score indicated a high 8-year fatality risk of 22.6%.
• Metabolic assessment revealed dysregulated glucose metabolism, despite a normal HbA1c.
• High lipoprotein (a) levels (307 nmol/L), a likely contributor to coronary risk and the finding of which also provided an explanation for his strong family history of cardiovascular disease, since raised LP a is inherited as an autosomal dominant gene.

His FAI CT depicted above shows the extent of coronary plaque present in all three coronary vessels with  high fat attenuation index  which puts the patient into a high risk category

Although the patient had a normal HbA1C and is defined as ‘non diabetic’, his continuous glucose monitor results shown above revealed multiple glucose excursions over 7.8 and 10 mmol/L, dramatically different from the profile typically seen in a healthy patient without heart disease with the same HbA1c  (illustrated below for comparison).

Interventions Implemented:

• Lipid management: High-dose statin therapy was initiated with a target LDL of under 1.6 mmol/L.
• Dietary modification: The patient was guided towards a lower carbohydrate diet, eliminating high-glycaemic foods such as honey on his morning oats/porridge and excessive high fructose fruit intake, a dietary choice he previously thought was ‘healthy’.He used CGM biofeedback to experiment with food choices until he arrived at a mixed diet that he found palatable and which was associated with reducing waist measurement and healthier  weight.
• Blood pressure optimisation: Ambulatory blood pressure monitoring led to adjustments in antihypertensive medication, including the addition of eplerenone.

Through these interventions, we believe the patient will significantly reduce his cardiovascular risk and has gained a better understanding of his metabolic health.

Expanding the Cardiometabolic Clinic’s Capabilities

SCVC’s commitment to advancing preventative medicine has led to the expansion of its cardiometabolic clinic. Innovations include:

1. Metabolic Health Assessments – A comprehensive suite of tests assessing glucose regulation, lipid profiles, and cardiovascular risk factors. These include the CarbR test that can done from home.
2. Medical Nutritional Therapy – Providing dietary interventions for patients with prediabetes and metabolic disorders to restore optimal glucose control.
3. GLP-1 memetic therapy – Nurse-led GLP-1 dosing services streamline the prescribing and monitoring of GLP-1 receptor agonists, which have been shown to reduce cardiovascular events.
4. Expanded Pharmacotherapy Options – Including SGLT2 inhibitors, metformin, GLP 1- mimetic and other insulin-sensitising agents to optimise metabolic and cardiovascular health.

The Role of Lifestyle Interventions

Beyond pharmacotherapy and diagnostic advancements, SCVC emphasises the critical role of lifestyle interventions in improving cardiometabolic health. Key lifestyle strategies include:

• Personalised Nutrition Plans – Tailored to patients’ glucose regulation needs, focusing on low-glycaemic diets.
• Exercise Programmes – Designed to enhance insulin sensitivity and cardiovascular endurance.
• Behavioural Coaching – Helping patients adopt and sustain long-term healthy habits.

The Future of Cardiometabolic Care at SCVC

With continued advancements in imaging, pharmacology, and personalised medicine, the SCVC cardiometabolic clinic is positioned to lead the way in preventative cardiology. The integration of real-time metabolic assessments, cutting-edge lipid profiling, and targeted pharmacotherapy represents a paradigm shift in how cardiovascular risk is managed.

As more cardiologists and healthcare providers recognise the significance of early metabolic assessment, SCVC aims to expand its services further, incorporating even more sophisticated diagnostic tools and intervention strategies to continue improving patient outcomes.

Conclusion

SCVC’s cardiometabolic clinic is at the forefront of preventative cardiovascular medicine, providing patients with access to comprehensive metabolic assessments, innovative imaging technologies, and multidisciplinary expertise. By identifying risk factors early and implementing targeted interventions, the clinic plays a pivotal role in reducing the burden of cardiovascular disease and improving long-term health outcomes. As cardiometabolic care continues to evolve, SCVC remains committed to pioneering new approaches in preventative medicine, ensuring that patients receive the highest standard of care for their cardiovascular and metabolic health

Further reading

1. Cardiometabolic Clinics: Is There a Need for a Multidisciplinary Clinic? 2022
2. The Metabolic health assessment
3. How to manage a dysregulated glucose?
4. My glucose spikes: so what?
5. Glucose: A Matter of Life and Death

The Naked Heart is an educational project owned and operated by Dr Edward Leatham. It comprises a series of blog articles, videos and reels distributed on Tiktok, Youtube and Instagram  aimed to help educate both patients and healthcare professionals about cardiology related issues.

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