Welcome to Cardiovascular Endocrinology

Effects of exercise on adrenocortical function.

A few months ago, I announced that the JCEM had begun a series on Cardiovascular Endocrinology, in keeping with the theme of this month's Annual Meeting of The Endocrine Society.Recognizing that this important area of endocrinology has not received the attention it deserves, our President, John Baxter, asked each of The Endocrine Society Journals to highlight this theme for June.In 2003, the JCEM has already published two special feature articles in cardiovascular endocrinology:

Environmental endocrine disrupting chemicals (EDCs), including pesticides and industrial chemicals, have been and are released into the environment producing deleterious effects on wildlife and humans. The effects observed in animal models after exposure during organogenesis correlate positively with an increased incidence of malformations of the male genital tract and of neoplasms and with the decreased sperm quality observed in European and US populations. Exposure to EDCs generates additional effects, such as alterations in male and female reproduction and changes in neuroendocrinology, behavior, metabolism and obesity, prostate cancer and thyroid and cardiovascular endocrinology. This Review highlights the carcinogenic properties of EDCs, with a special focus on bisphenol A. However, humans and wildlife are exposed to a mixture of EDCs that act contextually. To explain this mindboggling complexity will require the design of novel experimental approaches that integrate the effects of different doses of structurally different chemicals that act at different ages on different target tissues. The key to this complex problem lies in the adoption of mathematical modeling and computer simulations afforded by system biology approaches. Regardless, the data already amassed highlight the need for a public policy to reduce exposure to EDCs.

Welcome to Cardiovascular Endocrinology & Metabolism. In 2018, we are expanding the scope of the journal. A major aspect of the stated mission of this journal is to constructively erode silos of clinical and research activity. Specifically, it has been our aim to facilitate knowledge transfer between endocrinology and cardiovascular medicine. A second-level consideration concerns the distinction between the closely related disciplines of endocrinology, diabetes and metabolism. These specialties, although often intersecting in the clinic, remain segregated to some extent. This convention is reflected in dedicated scientific and professional care societies, separate major scientific conferences for each specialty, and the number of medical journals that are devoted to either endocrinology or diabetes rather than to both subjects together. Beyond the focus on hyperglycemia, diabetes is intimately associated with other derangements of other aspect of intermediary metabolism; for example, defects in aspects of lipid metabolism are usually encountered in the setting of even minor degrees of glucose intolerance. We wish to encourage submissions of all aspects of endocrinology, diabetes, and metabolism that are relevant to vascular disease. This journal’s international editorial board is being reconstituted to reflect this expanded perspective. Developments in molecular genetics, metabolomics, and lipidomics are helping to dissect the associations between metabolic and vascular disorders with ever greater precision. Moreover, there is increasing recognition of the importance of combined metabolic-vascular actions of novel pharmacotherapies. The notable reductions in heart failure in high-risk patients with type 2 diabetes treated with sodium-glucose transporter-2 (SGLT2) inhibitors, which were not predicted, points to effects, possibly hemodynamic, beyond reductions in hyperglycemia. The potential for pharmacological interventions to influence multiple aspects of metabolism in the context of cardiovascular risk reduction is also of interest. It is only recently that statins have been demonstrated to confer a small increase in risk of new-onset diabetes. This realization provided pause for thought about a drug class that had hitherto been regarded as having only positive metabolic effects. The diabetogenic effects of statins emphasizes the potential for adverse consequences, that is, hyperglycemia, arising from a pharmacological intervention that targets another aspect of metabolism, i.e. low-density lipoprotein-cholesterol. Proprotein convertase subtilisin kexin 9 (PCSK9) inhibitors provide even greater reductions in low-density lipoprotein-cholesterol levels. To date, however, no signal of elevated diabetes risk has been observed with these potent new agents. In addition to metabolic disease, this journal’s interest in the relevance of pituitary, adrenal, and reproductive endocrinology to vascular physiology and disease remains undiminished. Suggestions about future directions for the journal are welcome. Andrew J. Krentz, MD, FRCP Editor-in-Chief

Women in science.

Welcome to a new series of articles commissioned for Cardiovascular Endocrinology. The aim of these papers, each authored by an expert endocrinologist, cardiologist, other healthcare professionals, or scientists, is to present a summary of clinical aspects of diabetes and cardiometabolic disease in a particular region of the world. These considerations include aspects of pathogenesis, prevalence and clinical management. Global variations in diabetes and its complications are well recognized. Prominent examples include the increased propensity for type 2 diabetes and its long-term complications in non-White populations, especially among indigenous people, and the elevated and rising prevalence of type 1 diabetes among people of European descent 1–3. It is known that diabetes may have specific pathophysiological features in some parts of the globe or within certain populations. Examples of the latter include fibrocalculous form of secondary diabetes in the tropics 4 and reports of ketosis-prone type 2 diabetes among individuals of African ancestry 5. Moreover, the determinants of type 2 diabetes, in particular obesity and associated cardiometabolic risk factors - for example, dyslipidaemia, hypertension and inflammation - are of significant concern not only in western countries but now increasingly throughout the world. Local challenges in managing the increasing number of people with diabetes are also highly relevant. All healthcare systems are struggling with the rising number of people with diabetes and associated complications - in particular, coronary heart disease, heart failure and stroke. The excess risk for atherothrombotic vascular disease shows evidence of geographic and ethnic variations 6. The International Diabetes Federation suggests that each year 5 million deaths are directly attributable to diabetes – more than HIV/AIDS, tuberculosis and malaria combined (http://www.diabetesatlas.org). Diabetes is also a leading cause of visual loss, progressive renal impairment and nontraumatic amputations mediated by compromised microvascular structure and function 7. Yet, millions who are at risk for these potentially devastating complications remain undiagnosed. In the Middle East and North Africa this situation pertains to an estimated four out of 10 adults according to the International Diabetes Federation. Global health expenditure on diabetes is already estimated to consume 12% of total health expenditure. The great majority of people with diabetes live in middle-income or low-income countries where advances in diabetes care often remain beyond reach 8. Disparities in care – including access to diagnostics considered standard in western countries and difficulties even in obtaining or affording insulin – are all too evident in many countries 8. We hope the series will help broaden the perspective of clinicians and researchers focused on diabetes from all parts of the globe.