Let me introduce you to one of the biggest public health problems

of the modern time,

called cardiometabolic diseases.
I am talking about a group of nutrition-related disorders
that form the largest contributor to mortality worldwide,
both in men and women.
They kill almost 18 million people each year,
which is around one-third of all deaths.
Not only in western societies, like the United States, Australia and Europe,
but also in Asia and emerging economies in Africa.
Cardiometabolic diseases are not just related to excess mortality.
They are also a major cause of morbidity,
which comes with hospitalisations, medical therapies
and long-term medication use.
They cost our societies a lot of money.
When I talk about cardiometabolic diseases,
I refer to a cluster of disorders.
First and foremost, this cluster includes coronary heart disease,
mainly heart attacks,
and type 2 diabetes.
Let's have a look into the underlying disease processes,
or pathophysiology.
We can see metabolic problems like insulin resistance
and low-grade inflammation.
And also abnormal levels of cholesterol and other lipids in the blood,
called dyslipidemia.
We may also see high blood pressure, called hypertension,
and abnormalities in the blood vessels, or vascular dysfunction.
These problems are not only found in heart disease,
but also in ischemic stroke and chronic kidney disease.
That's why we also include these disorders
in the cardiometabolic cluster.
Why do we see so many cardiometabolic diseases around the globe,
what do you think?
Well, that has to do with our modern lifestyle.
At least 80% of cardiometabolic diseases are caused by smoking,
unhealthy eating, and lack of exercise.
These habits have a large impact on biological risk factors
and the disease process.
Let's have a look at countries that undergo economic development,
where people move from rural areas to the big cities.
In these countries, traditional lifestyle is replaced by unhealthy habits.
Within decades, this causes a dramatic increase in obesity,
diabetes and heart disease.
We can also see this when people migrate from a traditional
to a modern society.
For example, Japanese men who moved to the United States
in the early 20th century had a 2 to 3 times higher risk of heart attacks
in the 1950s than men who stayed behind in Japan.
So is it all our own fault, resulting from modern lifestyle?
What about our DNA,
is there no such thing as genetic predisposition?
Well, yes, you have a point there.
Some people more easily get cardiometabolic disease than others
because of their genetic makeup.
But your DNA may not be as important as you think...
Less than 10% of cardiometabolic disease can be explained
from genes alone.
In other words:
if people with "bad genes" spend their lives in a healthy environment,
their chance of getting a heart attack or type 2 diabetes is low.
The recent diabetes epidemic in Asia is not caused by genetic changes
in the population...
Bad habits are to blame!
Now that we know that lifestyle is more important than genes,
that's also good news:
cardiometabolic diseases are largely preventable!
But how?
Well, medicine has lots to offer...
Doctors can prescribe medication for lowering blood pressure and cholesterol.
Or offer gastric bypass surgery to obese people,
so that they won't get diabetes.
But treatment of high-risk patients by medical doctors
is by far not sufficient for lowering the burden of disease in society.
And I will tell you why.
It's because many hospitalisations and deaths
occur in people with only mildly elevated risk factors,
who haven't seen a doctor yet.
And these people form the biggest part of our population.
In other words, a large number of people at small or average risk
may give rise to more cases of disease
than a small number of people at high risk.
That sounds a bit weird, isn't it?
We call this the prevention paradox.
To lower the burden of cardiometabolic diseases in our societies,
we should not only treat patients
but we must also reach people who do not require medical treatment yet.
We need a population approach
that promotes healthy diets and lifestyles,
from early life onwards.
That's not only the task of public health workers and nutritionists.
Politics and the food industry must also be involved.
During this course, we will zoom into the different cardiometabolic disorders
and how they are influenced by nutrition and lifestyle.
We will make you better understand the risk factors
and disease processes,
and give you clues for prevention and future research.
I hope that you are eager to learn more about the complex,
but fascinating field of nutrition and cardiometabolic diseases.