Cardiometabolic Clinic: Treatment at the Intersection of Diabetes and Heart Disease

Heart disease is the leading cause of death in people with diabetes. That may be surprising to those who consider diabetes just a problem of excess blood sugar or weight, but it’s true.

Statistically, those with diabetes have between twice and four times the risk of dying from coronary artery disease and stroke, according to studies published in the Journal of the American Heart Association.

In an effort to improve outcomes for these patients, Baptist Health Miami Cardiac & Vascular Institute has launched a Cardiometabolic Clinic, the first – and, so far, only – program of its kind in South Florida. It takes a multidisciplinary approach to addressing a wide range of risk factors, particularly among patients with diabetes and other metabolic conditions.

Adedapo Iluyomade, M.D., preventive cardiologist at Baptist Health Miami Cardiac & Vascular Institute.

“We’re at the forefront of this new field,” says Adedapo Iluyomade, M.D., a preventive cardiologist with the clinic. “This is a very new subspecialty within cardiology.”

While the statistics may seem daunting, patients can take control of their health, implement prevention measures and even reverse some of the damage that has been done, Dr. Iluyomade says.

Optimal cardiovascular health is alarmingly rare in the U.S, according to the American College of Cardiology. Researchers found that fewer than 7 percent of U.S. adults meet the healthiest standards of five major areas related to heart and metabolic health: weight, blood sugar, blood pressure, cholesterol and cardiovascular disease status.

“There’s a cluster of these interrelated risk factors. All of these work together to cause diabetes-associated cardiovascular disease, as well as kidney disease and fatty liver disease,” explains Dr. Iluyomade.

Because the conditions are so closely linked, treating them together is the most strategic and comprehensive approach, he says.

“If you think about a patient who has diabetes, hypertension, fatty liver disease or kidney disease, that patient may seek care from three or four specialists who usually work in silos in their own areas. What you need is someone to look at the whole picture,” Dr. Iluyomade says.

“Ultimately, we’re all trying to prevent adverse outcomes. We want to prevent a heart attack, we want to prevent a stroke, we want to prevent someone from ending up on diabetes medications or on dialysis,” Dr. Iluyomade explains. “But all of it needs to fit together in order to reduce the risk as effectively as possible.”

Comprehensive treatment includes blood pressure management, lipid-lowering therapies, glucose-lowering medications with demonstrated cardiovascular benefits, and a reduction of inflammation. The program also involves nutrition guidance, education and social work components.

“Our program is designed for those patients for whom it is a little more tricky, where it is a little more complex. So we have a registered dietitian, we have a clinical pharmacist, we have a nurse navigator. We can help with getting some of these newer medications authorized. We can follow up with patients very closely.”

The care is highly individualized, Dr. Iluyomade says. “Every patient is different, so that means what’s driving their risk is different.”

Newer medications are quite effective in the fight against cardiometabolic disease if patients make proactive efforts to improve their lifestyle, Dr. Iluyomade notes. And being treated at an interdisciplinary clinic is more convenient for patients, encouraging progress and allowing for more effective adherence and follow-up. “You can’t be afraid of following up with the physician, of getting that repeat A1C test, of getting that repeat cholesterol panel or of getting on the scale,” Dr. Iluyomade says. “You need to know your trajectory.”

About 47 million people in the United States are living with cardiometabolic disorders.  “It's not something that is rare,” Dr. Iluyomade says, “but it is something that we can do something about.”

The concept of using a dedicated multidisciplinary clinic to treat cardiometabolic disorders is novel, but growing. To multiply its impact, Miami Cardiac & Vascular Institute has become a charter member of the Cardiometabolic Center Alliance, a national collaborative of healthcare organizations committed to helping patients better manage their conditions. “We’re really a leader in this. We are trying to take a different approach to care,” Dr. Iluyomade says.

Patients seeking to consolidate their care should discuss the possibility with their physicians, Dr. Iluyomade says.

“It's very easy for primary care providers, or for any physician, to request a consult with our cardiometabolic program,” he says. “We rely on cardiologists and on primary care physicians to help identify patients who would benefit from our program. But the initiative can also come from patients.”