“Multi-System Dialogue” and “Multi-Disciplinary Co-Management” of Cerebro-Metabolic Disease

doi:10.3969/j.issn.1673-5765.2024.02.001

Abstract

Abstract: Cerebro-metabolic disease is a recently proposed concept primarily referring to cerebrovascular injury caused by both traditional and residual metabolic risk factors. It represents a clinical syndrome in which intervention in metabolic risk factors can effectively improve the prognosis. Metabolic pathways do not exist independently. Various metabolic pathways in multiple organs such as the brain, heart, liver, kidneys, and intestines interact, collaborate, and intertwine to form the metabolic network of the human body. The abnormality in the metabolic network leads to the occurrence of cerebro-metabolic disease. Moreover, the presence of metabolic risk factors can simultaneously cause injury to multiple target organs, and the nervous system interacts with the cardiovascular system, endocrine system, digestive system, and others through various pathophysiological processes. Therefore, future research on cerebro-metabolic disease will gradually tend to multi-organ level in mechanism exploration and disease treatment, and develop into a multidisciplinary management approach.

Key words: Cerebro-metabolic disease; Cerebro-metabolic risk; Comprehensive multidisciplinary management

摘要： 代谢性脑血管病是一个新近提出的概念，指由传统代谢危险因素和残余代谢危险因素引起的脑血管损害，通过干预代谢危险因素可有效改善其预后的一种临床综合征。代谢途径并非独立存在，脑、心脏、肝脏、肾脏和肠道等多个器官的各种代谢途径相互影响、共同作用、交织成网，构成了人体的代谢网络，而代谢网络的异常导致了代谢性脑血管病的发生。同时，代谢危险因素的存在可同时造成多个靶器官损害，且神经系统与心血管系统、内分泌系统、消化系统等可通过多种病理生理过程相互影响。因此，代谢性脑血管病未来在机制探究和疾病治疗等方面将逐渐倾向于多器官水平，并向多学科管理模式发展。

关键词: 代谢性脑血管病; 脑血管代谢风险; 多学科综合管理

CLC Number:

XU Jie, WANG Yongjun. “Multi-System Dialogue” and “Multi-Disciplinary Co-Management” of Cerebro-Metabolic Disease[J]. Chinese Journal of Stroke, 2024, 19(2): 125-129.

许杰, 王拥军. 代谢性脑血管病的“多系统对话”与“多学科共管”[J]. 中国卒中杂志, 2024, 19(2): 125-129.

References

[1] 王拥军，李子孝，谷鸿秋，等. 中国卒中报告2020（中文版）（1）[J]. 中国卒中杂志，2022，17（5）：433-447.
WANG Y J，LI Z X，GU H Q，et al. China stroke statistics 2020（1）[J]. Chin J Stroke，2022，17（5）：433-447.
[2] 许杰，王拥军. 代谢性脑血管病：概念、方法、挑战和未来方向[J]. 中国卒中杂志，2023，18（6）：617-627.
XU J，WANG Y J. Cerebro-metabolic disease：concept，method，challenge and future directions[J]. Chin J Stroke，2023，18（6）：617-627.
[3] UNWIN N. The metabolic syndrome[J]. J R Soc Med，2006，99（9）：457-462.
[4] SALAS-SALVADÓ J，DÍAZ-LÓPEZ A，RUIZ-CANELA M，et al. Effect of a lifestyle intervention program with energy-restricted Mediterranean diet and exercise on weight loss and cardiovascular risk factors：one-year results of the PREDIMED-Plus trial[J]. Diabetes Care，2019，42（5）：777-788.
[5] WILKINSON M J，MANOOGIAN E N C，ZADOURIAN A，et al. Ten-hour time-restricted eating reduces weight，blood pressure，and atherogenic lipids in patients with metabolic syndrome[J/OL]. Cell Metab，2020，31（1）：92-104，e5[2023-11-10].
https://doi.org/10.1016/j.cmet.2019.11.004.
[6] DEEDWANIA P，MURPHY S A，SCHEEN A，et al. Efficacy and safety of PCSK9 inhibition with evolocumab in reducing cardiovascular events in patients with metabolic syndrome receiving statin therapy[J]. JAMA Cardiol，2021，6（2）：139-147.
[7] LEWIS G F，CARPENTIER A，ADELI K，et al. Disordered fat storage and mobilization in the pathogenesis of insulin resistance and type 2 diabetes[J]. Endocr Rev，2002，23（2）：201-229.
[8] SEMOVA I，LEVENSON A E，KRAWCZYK J，et al. Insulin prevents hypercholesterolemia by suppressing 12α-hydroxylated bile acids[J]. Circulation，2022，145（13）：969-982.
[9] JIA G H，SOWERS J R. Hypertension in diabetes：an update of basic mechanisms and clinical disease[J]. Hypertension，2021，78（5）：1197-1205.
[10] WU H，BALLANTYNE C M. Metabolic inflammation and insulin resistance in obesity[J]. Circ Res，2020，126（11）：1549-1564.
[11] RIDKER P M，EVERETT B M，THUREN T，et al. Antiinflammatory therapy with canakinumab for atherosclerotic disease[J]. N Engl J Med，2017，377（12）：1119-1131.
[12] TORRES S，FABERSANI E，MARQUEZ A，et al. Adipose tissue inflammation and metabolic syndrome. The proactive role of probiotics[J]. Eur J Nutr，2019，58（1）：27-43.
[13] HUSAIN M，BIRKENFELD A L，DONSMARK M，et al. Oral semaglutide and cardiovascular outcomes in patients with type 2 diabetes[J]. N Engl J Med，2019，381（9）：841-851.
[14] HUSAIN M，BAIN S C，JEPPESEN O K，et al. Semaglutide（SUSTAIN and PIONEER）reduces cardiovascular events in type 2 diabetes across varying cardiovascular risk[J]. Diabetes Obes Metab，2020，22（3）：442-451.
[15] STRAIN W D，FRENKEL O，JAMES M A，et al. Effects of semaglutide on stroke subtypes in type 2 diabetes：post hoc analysis of the randomized SUSTAIN 6 and PIONEER 6[J]. Stroke，2022，53（9）：2749-2757.
[16] LINCOFF A M，BROWN-FRANDSEN K，COLHOUN H M，et al. Semaglutide and cardiovascular outcomes in obesity without diabetes[J]. N Engl J Med，2023，389（24）：2221-2232.
[17] American Diabetes Association Professional Practice Committee. 9. Pharmacologic approaches to glycemic treatment：standards of care in diabetes—2024[J/OL]. Diabetes Care，2024，47（Supplement_1）：S158-S178[2024-01-10]. https://doi.org/10.2337/dc24-S009.
[18] BALLANTYNE C M，BANACH M，MANCINI G B J，et al. Efficacy and safety of bempedoic acid added to ezetimibe in statin-intolerant patients with hypercholesterolemia：a randomized，
placebo-controlled study[J/OL]. Atherosclerosis，2018，277：195-203[2023-11-10]. https://doi.org/10.1016/j.atherosclerosis.2018.06.002.
[19] LAUFS U，BANACH M，MANCINI G B J，et al. Efficacy and safety of bempedoic acid in patients with hypercholesterolemia and statin intolerance
[J/OL]. JAHA，2019，8（7）：e011662[2023-12-01]. https://doi.org/10.1161/JAHA.118.011662.
[20] GOLDBERG A C，LEITER L A，STROES E S G，et al. Effect of bempedoic acid vs placebo added to maximally tolerated statins on low-density lipoprotein cholesterol in patients at high risk for cardiovascular disease[J]. JAMA，2019，322（18）：1780-1788.
[21] FAN J N，SUN Z J，YU C Q，et al. Multimorbidity patterns and association with mortality in 0.5 million Chinese adults[J]. Chin Med J（Engl），2022，135（6）：648-657.
[22] MARASSI M，FADINI G P. The cardio-renal-metabolic connection：a review of the evidence
[J/OL]. Cardiovasc Diabetol，2023，22（1）：195[2023-12-01]. https://doi.org/10.1186/s12933-023-01937-x.
[23] HAN Y T，HU Y Z，YU C Q，et al. Duration-dependent
impact of cardiometabolic diseases and multimorbidity on all-cause and cause-specific mortality：a prospective cohort study of 0.5 million participants
[J/OL]. Cardiovasc Diabetol，2023，22（1）：135[2023-11-10]. https://doi.org/10.1186/s12933-023-01858-9.
[24] 中华医学会心血管病学分会代谢性心血管疾病学组，中华心血管病杂志编辑委员会. 心血管病合并糖代谢异常患者心血管风险综合管理中国专家共识[J]. 中华心血管病杂志，2021，49（7）：656-672.
Chinese Society of Cardiology of Chinese Medical Association，Metabolic Cardiovascular Disease Group，Editorial Board of Chinese Journal of Cardiology. Chinese expert consensus on comprehensive management of cardiovascular risk in patients with cardiovascular diseases and abnormal glucose metabolism[J]. Chin J Cardiol，2021，49（7）：656-672.
[25] MARX N，FEDERICI M，SCHÜTT K，et al. 2023 ESC guidelines for the management of cardiovascular disease in patients with diabetes[J]. Eur Heart J，2023，44（39）：4043-4140.
[26] COSENTINO F，VERMA S，AMBERY P，et al. Cardiometabolic risk management：insights from a European Society of Cardiology cardiovascular round table[J]. Eur Heart J，2023，44（39）：4141-4156.