Integrated Management of Cardiovascular–Renal–Hepatic–Metabolic Syndrome: Expanding Roles of SGLT2is, GLP-1RAs, and GIP/GLP-1-RAs

Biomedicines, Journal Year: 2025, Volume and Issue: 13(1), P. 135 - 135

Published: Jan. 8, 2025

Cardiovascular-Kidney-Metabolic syndrome, introduced by the American Heart Association in 2023, represents a complex and interconnected spectrum of diseases driven shared pathophysiological mechanisms. However, this framework notably excludes liver-an organ fundamental to metabolic regulation. Building on concept, Cardiovascular-Renal-Hepatic-Metabolic (CRHM) syndrome incorporates liver's pivotal role disease spectrum, particularly through its involvement via dysfunction-associated steatotic liver (MASLD). Despite increasing prevalence CRHM unified management strategies remain insufficiently explored. This review addresses following critical question: How can novel anti-diabetic agents, including sodium-glucose cotransporter-2 inhibitors (SGLT2is), glucagon-like peptide-1 receptor agonists (GLP-1RAs), dual gastric inhibitory polypeptide (GIP)/GLP-1RA, offer an integrated approach managing beyond boundaries traditional specialties? By synthesizing evidence from landmark clinical trials, we highlight paradigm-shifting potential these therapies. SGLT2is, such as dapagliflozin empagliflozin, have emerged cornerstone guideline-directed treatments for heart failure (HF) chronic kidney (CKD), providing benefits that extend glycemic control are independent diabetes status. GLP-1RAs, e.g., semaglutide, transformed obesity enabling weight reductions exceeding 15% improving outcomes atherosclerotic cardiovascular (ASCVD), diabetic CKD, HF, MASLD. Additionally, tirzepatide, GIP/GLP-1RA, enables unprecedented loss (>20%), reduces risk over 90%, improves HF with preserved ejection fraction (HFpEF), MASLD, obstructive sleep apnea. moving organ-specific approach, propose integrates agents into holistic syndrome. paradigm shift moves away fragmented, organ-centric toward more fostering collaboration across specialties marking progress precision cardiometabolic medicine.

Language: Английский

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From Cardiovascular-Kidney-Metabolic Syndrome to Cardiovascular-Renal-Hepatic-Metabolic Syndrome: Proposing an Expanded Framework

Biomolecules, Journal Year: 2025, Volume and Issue: 15(2), P. 213 - 213

Published: Feb. 2, 2025

Cardiometabolic diseases represent an escalating global health crisis, slowing or even reversing earlier declines in cardiovascular disease (CVD) mortality. Traditionally, conditions such as obesity, type 2 diabetes mellitus (T2DM), atherosclerotic CVD, heart failure (HF), chronic kidney (CKD), and metabolic dysfunction-associated steatotic liver (MASLD) were managed isolation. However, emerging evidence reveals that these disorders share overlapping pathophysiological mechanisms treatment strategies. In 2023, the American Heart Association proposed Cardiovascular-Kidney-Metabolic (CKM) syndrome, recognizing interconnected roles of heart, kidneys, system. Yet, this model omits liver—a critical organ impacted by dysfunction. MASLD, which can progress to steatohepatitis (MASH), is closely tied insulin resistance contributing directly renal impairment. Notably, MASLD bidirectionally associated with development progression CKM syndrome. As a result, we introduce expanded framework—the Cardiovascular-Renal-Hepatic-Metabolic (CRHM) syndrome—to more comprehensively capture broader inter-organ dynamics. We provide guidance for integrated diagnostic approach aimed at halting advanced stages preventing further damage. addition, highlight advances medical management target shared pathways, offering benefits across multiple systems. Viewing whole, rather than discrete entities, incorporating into framework fosters holistic strategy offers promising path addressing cardiometabolic pandemic.

Language: Английский

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Sarcopenia and Cardiogeriatrics: The Links Between Skeletal Muscle Decline and Cardiovascular Aging

Nutrients, Journal Year: 2025, Volume and Issue: 17(2), P. 282 - 282

Published: Jan. 14, 2025

Sarcopenia, an age-related decline in skeletal muscle mass, strength, and function, is increasingly recognized as a significant condition the aging population, particularly among those with cardiovascular diseases (CVD). This review provides comprehensive synthesis of interplay between sarcopenia cardiogeriatrics, emphasizing shared mechanisms such chronic low-grade inflammation (inflammaging), hormonal dysregulation, oxidative stress, physical inactivity. Despite advancements diagnostic frameworks, EWGSOP2 AWGS definitions, variability criteria assessment methods continues to challenge standardization. Key tools include dual-energy X-ray absorptiometry (DXA) bioimpedance analysis (BIA) for alongside functional measures grip strength gait speed. The highlights bidirectional relationship conditions heart failure, aortic stenosis, atherosclerotic disease, which exacerbate each other through complex pathophysiological mechanisms. Emerging therapeutic strategies targeting mTOR pathway, NAD+ metabolism, senescence-related processes offer promise mitigating sarcopenia’s progression. Additionally, integrated interventions combining resistance training, nutritional optimization, novel anti-aging therapies hold potential improving outcomes. paper underscores critical gaps evidence, including need longitudinal studies establish causality validation advanced approaches clinical settings. Future research should leverage multi-omics technologies machine learning identify biomarkers personalize interventions. Addressing these challenges essential reducing burden enhancing quality life elderly individuals comorbid conditions. aims guide future promote effective, individualized management strategies.

Language: Английский

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The Human Energy Balance: Uncovering the Hidden Variables of Obesity

Diseases, Journal Year: 2025, Volume and Issue: 13(2), P. 55 - 55

Published: Feb. 13, 2025

Obesity has emerged as a global epidemic, creating an increased burden of weight-related diseases and straining healthcare systems worldwide. While the fundamental principle energy balance-caloric intake versus expenditure-remains central to weight regulation, real-world outcomes often deviate from simplistic predictions due multitude physiological environmental factors. Genetic predispositions, variations in basal metabolic rates, adaptive thermogenesis, physical activity, nutrient losses via fecal urinary excretion contribute interindividual differences homeostasis. Additionally, factors such meal timing, macronutrient composition, gut microbiota dynamics, diet-induced thermogenesis (DIT) further modulate utilization efficiency. This Perspective explores key determinants balance, while also highlighting clinical significance thrifty spendthrifty phenotypes. Key strategies for individualized management include precision calorimetry, circadian-aligned use protein- whole food diets enhance DIT, increases non-exercise well mild cold exposure thermogenic agents (e.g., capsaicin-like compounds) stimulate brown adipose tissue activity. A comprehensive, personalized approach obesity that moves beyond restrictive caloric models is essential achieving sustainable control improving long-term health. Integrating these multifactorial insights into practice will treatment strategies, fostering more effective enduring interventions.

Language: Английский

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Skin Microbiota: Mediator of Interactions Between Metabolic Disorders and Cutaneous Health and Disease

Microorganisms, Journal Year: 2025, Volume and Issue: 13(1), P. 161 - 161

Published: Jan. 14, 2025

Metabolic disorders, including type 2 diabetes mellitus (T2DM), obesity, and metabolic syndrome, are systemic conditions that profoundly impact the skin microbiota, a dynamic community of bacteria, fungi, viruses, mites essential for cutaneous health. Dysbiosis caused by dysfunction contributes to barrier disruption, immune dysregulation, increased susceptibility inflammatory diseases, psoriasis, atopic dermatitis, acne. For instance, hyperglycemia in T2DM leads formation advanced glycation end products (AGEs), which bind receptor AGEs (RAGE) on keratinocytes cells, promoting oxidative stress inflammation while facilitating Staphylococcus aureus colonization dermatitis. Similarly, obesity-induced dysregulation sebaceous lipid composition increases saturated fatty acids, favoring pathogenic strains Cutibacterium acnes, produce metabolites exacerbate Advances metabolomics microbiome sequencing have unveiled critical biomarkers, such as short-chain acids microbial signatures, predictive therapeutic outcomes. example, elevated butyrate levels psoriasis been associated with reduced Th17-mediated inflammation, presence specific Lactobacillus has shown potential modulate tolerance Furthermore, machine learning models increasingly used integrate multi-omics data, enabling personalized interventions. Emerging therapies, probiotics postbiotics, aim restore diversity, phage therapy selectively targets bacteria like without disrupting beneficial flora. Clinical trials demonstrated significant reductions lesions improved quality-of-life metrics patients receiving these microbiota-targeted treatments. This review synthesizes current evidence bidirectional interplay between disorders highlighting implications future directions. By addressing microbiota-mediated pathways, precision strategies paving way patient outcomes dermatologic care.

Language: Английский

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Burden of Cardiovascular Hospitalizations and In-Hospital Mortality in Greece: National Trends Over Five Years

Hellenic Journal of Cardiology, Journal Year: 2025, Volume and Issue: unknown

Published: April 1, 2025

Nationwide epidemiological studies provide crucial insights into the burden of prevalent and emerging diseases, guiding development targeted health policies. This study analyzes trends in cardiovascular disease (CVD) hospitalizations in-hospital mortality Greece. Anonymized data were retrieved from Hellenic Statistical Authority to calculate hospitalization rates (HRs) per 100,000 population for (CV) sub-causes 2013 2017. The statistical significance temporal was assessed using generalized linear models Python. From 2017, HRs myocardial infarctions (MIs) increased by 9.2%, heart failure (HF) 34.5%, stroke 12.3%, cardiac arrest 62.7%, pulmonary embolism 36.6%. Focusing on CVD leading cause (14%) with a HR 1,942.4 population, HF being CV sub-cause (12%). together stroke, atrial fibrillation/flutter (AF/Af), coronary artery represented over 60% all hospitalizations. While more among males, HF, strokes, AF/Af primary females. higher males majority sub-causes. Females exhibited across major demonstrated significant shifts Greece, increasing MIs HF. These findings highlight need optimization guideline implementation, specialized units cardiogeriatric centers address challenges posed aging population.

Language: Английский

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Metabolic Characteristics of Obese Adolescents with Different Degrees of Weight Loss After Identical Exercise Training Intervention

Metabolites, Journal Year: 2025, Volume and Issue: 15(5), P. 313 - 313

Published: May 7, 2025

Objectives: This study aims to elucidate the metabolic differences between obese adolescents categorized into low-weight-loss (LWL) and high-weight-loss (HWL) groups. Methods: The objective of this is investigate characteristics adolescents, with a focus on statistically significant individual observed in weight loss outcomes after same dietary exercise training intervention. A four-week intervention was administered participants. Obese were LWL (with percentage 5–10%) HWL >10%) groups basis their outcomes. Post-intervention changes body morphology composition two compared using Analysis Covariance (ANCOVA), gender as covariate. Additionally, analyzed depth; differential metabolites identified through ANCOVA adjusted for gender, followed by pathway analysis. Results: After intervention, showed improvements those before (p < 0.001). For example, decreased from 80.65 kg 72.35 kg, BMI 30.57 kg/m2 27.26 kg/m2, waist circumference 103.64 cm 94.72 cm, fat 32.68% 28.54%. Prior no > 0.05). group demonstrated weight, mass index, circumference, percentage, mass, fat-free water amount, skeletal muscle controlling levels pre-intervention metabolites, 27 These fatty acids, amino organic carnitines, indoles, benzoic carbohydrates. Notably, they significantly enriched eight pathways involved acid metabolism, biosynthesis, coenzyme biosynthesis. Conclusions: enhanced physical fitness although degree varied among individuals. Considerable reduction correlated lipid, acid, carbohydrate, gut microbiota metabolism enrichment findings indicate that intrinsic considerably influence responsiveness exercise-based weight-loss interventions.

Language: Английский

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