It is a metabolically active tissue that metabolises a number of up‐regulation and thrombogenic immune cells. Elevated plasma unsaturated fatty acid accumulation and inordinate release of lipids from adipocytes can hinder the ability of insulin to stimulate muscle glucose metabolism and suppress hepatic glucose production (Figure 2.2) (Kirk and Klein 2009). In juveniles, insulin tolerance tends to be related to a decline in the mitochondrial to nuclear DNA ratio. Elevated secretion of lipids from adipocytes is attributed to insulin sensitivity leading to a decline in glucose transmission through the muscles (Gill et al. 2005). Hyperinsulinemia has been reported as a significant prognostic factor in broad prospective epidemiologic trials. In conclusion, there is considerable proof that the most prevalent forms of the metabolic syndrome are correlated to abdominal obesity, especially when it is followed by abdominal adipocytes accumulation.
Figure 2.2 Dysregulation of sugar metabolism leads to cardiometabolic syndrome.
Source: Based on Kirk and Klein (2009).
2.4 Urbanisation as a Factor to Increase Cardiometabolic and Cardiovascular Disorders
2.4.1 The Driving Development of Urbanisation and Its Implications on Cardiovascular Syndrome in the Twenty‐First Century
The birth of the metropolis has been a recent development in the latest generations. Backwoods regions have previously been urbanised; along with that many people have migrated to urban areas. In recent studies, it has been observed that the various risks of cardiometabolic and CVD begin in premature conditions of pregnant mothers, or at the time of birth. The risk increases more due to many factors like lack of physical activity, unhealthy diet, consumption of alcohol and tobacco, smoking, etc. Many of these exposures have increased due to the negative impacts of urbanisation. Although urbanisation has brought major improvements in the economy and many lifestyle opportunities like working variations, diversity to education, fast internet, and social world development and political mobilisation, but this poses a great obstruction towards maintaining a healthy lifestyle and behaviour (Figure 2.3). Taking into consideration man‐made landscapes, often in certain cases, industrialisation has occurred way too fast, leading to many defects in the construction of living places. As a result, a person has started to live in insubstantial conditions starting from cardboard boxes to pavements, under bridges, near streets, slums, sidewalks tents, etc. Individuals living in such conditions have low nutritious diets and less opportunities for medication and other daily exercises. People living in extremely well‐maintained houses are forced to sedentary behaviour due to lack of physical activity, less active in playing outside environment, not only that but much more addiction towards drinking and smoking. As a result, people residing in crowded places have a high risk to develop rheumatic heart disease (RHD), which causes damage to the heart muscle and heart valves. On the other hand, it has been said that children may suffer obesity due to maternal obesity during pregnancy; however, there is less proof to this statement (Castro et al. 2003). Individuals of low middle economic status are more open to street and cheap foods since they are easily available like open vendors as they have limited budget and less choice. Moreover, it has been noticed that people living in well‐maintained conditions are also at threat of developing cardiometabolic syndrome often seen due to much addiction in the social world (Münzel et al. 2017a). In addition to that smoking rate, consumption of drugs, alcohol among youth has increased rapidly which is ultimately leading them to stress, depression, anxiety, obesity, and early‐stage diabetes.
Figure 2.3 Complex urban planning and its impact on cardiometabolic syndrome.
2.4.2 Mutualistic Relationship Between Urbanisation and Ecosystem
Industrialisation has been one of the most prominent causes of population changes in recent years, which is propelled by a multitude of societal, financial, and ecological mechanisms. Through the development of towns, communities, and infrastructure upgrades, urbanisation altered natural and previous rural habitats (Miller and Hutchins 2017). Smart employee population levels, expanded rough areas (e.g. roads and buildings), enhanced toxicity (e.g. air quality, light, soil), and high temperature are all characteristics of the novel, human urban setting. The urban sprawl resonance is a form in which cities are hotter than non‐urban areas due to the increased impermeable surfaces (e.g. gravel and mortar) and significantly lower tree cover. The trend and intensity of the interaction between urbanisation and ecological consequences can differ and evolve with present, based on the geographic, societal, and financial factors as well as progress trajectories, according to emerging evidence (Bai et al. 2017). Poor air quality is a dynamic combination of airborne pollutants emitted by a wide range of sources, including factories, residential gasification heating systems, automobiles, and industrialisation. Domestic air emissions and urban chemical fumes are the third and ninth leading causes of death and disease, respectively. The latter two are contributing for 6.6 million deaths and 7.6% of global, with pollutants accounting for 3.5% of global disease burden (Münzel et al. 2017a).
CVD is also known to be the leading cause of mortality (Dey et al. 2020). Air contamination containing fine particulate matter with a diameter of less than 2.5 μm (PM2.5) is the world's leading cause of death rates. Rigorous disposal of pollutants from urban centres, combined with an increase in impermeable surfaces as a result of urbanisation, will lead to a steady decline in the health of urban aquatic habitats, defined as the urban stream syndrome (Bai et al. 2017). Pollution from faecal matter and microbial pathogens, as well as antimicrobial agents, is common in urban environments, particularly urban aquatic environments. Toxins from marine ecosystems can be exported to lands through irrigation of reclaimed water and urban‐influenced river/stream water, posing a health risk (Miles et al. 2019). Changes in the global land use adversely affect the ecology and the atmosphere shape local and global climate by leading to thermal zone effect and disrupted biodiversity and propel multinational agricultural and forestry trading. Metropolitan composition can minimise power usage and fossil fuel used by transportation, but it also enhances the heat island effect and restricts groundwater infiltration. Abiotic stresses such as destruction and elimination of natural events, which inhibit ecosystem regeneration during advanced development stages, may be worsened by urban development (Johnson et al. 2019). While increased population and economic activities are often highlighted, studies indicate that the associated growth in environmental consequences, as manifested in property transition, generation of waste, air and water pollution, among other things, is much larger and faster. More analysis is required on such an intensifying and accelerating trend in urbanisation‐environmental linkages (Li et al. 2019).
2.4.3 Why Is Urban Development a Challenge for Cardiometabolic Syndrome?
Heart disease has quite a significant global impact. The disease has a huge financial impact on healthcare services of any country. The persistent existence of the condition imposes a significant financial burden on patients and it has a negative impact on their quality of life. This strain has a negative impact on treatment compliance and adherence, which leads to further problems. The overall cost of medical care escalated by ~50% between patients aged 31–40 years and for those aged 61–70 years (World Heart Federation 2015). The expense of cardiometabolic syndrome in the society is indeed likely to rise as in the developed world, where cardiometabolic syndrome impacts a large percentage of working‐age adults. In the long term, universal healthcare will face significant economic challenges as a result
