Why Rheumatologists Should Focus on Patients’ Cardiovascular Health

Watching Pablo Sandoval’s belly burst his belt buckle on live TV during a recent Red Sox game got me thinking about the link between obesity and metabolic syndrome.
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Baseball is a great sport. It’s fascinating to watch the evolving duel between pitcher and batter. As the former employs their remarkably powerful and versatile rotator cuff and forearm flexor muscles to hurl blazing pitches, the latter engages their exceptionally honed hand–eye neural link to make contact with the ball. Baseball is the ultimate summertime sport: a slow-moving, drawn-out affair punctuated by the occasional hit or the occasional calamity. Consider what recently occurred when a hefty batter took a massive swing that not only failed to connect with the ball, but resulted in the strong torque forces bursting his belt buckle in front of 49,000 fans. This recent embarrassing mishap brought considerable unwanted attention to the player’s rather portly belly.¹ Fortunately for the batter, the recently acquired Boston Red Sox third baseman Pablo Sandoval, his pants did not fall down.

Mr. Sandoval has struggled with weight issues for most of his career, but when he became a free agent last fall, the Red Sox wasted no time in signing him to a multi-year, $95 million contract. After all, there is a long history of overweight ballplayers being successful at their craft, including the immortal Babe Ruth and the incredibly talented pitcher, C.C. Sabathia. Perhaps the team should have consulted with a nutritionist, because Mr. Sandoval is known to have a penchant for overeating.² The issue of his weight and its effect on his lackluster performance this year dogged him until a few weeks ago when he suffered a season-ending labral tear in his shoulder.

Pablo Sandoval’s story serves as a not-so-gentle reminder of the pervasive nature of the obesity epidemic that, save for Africa, has spread to every corner of the globe. As obesity rates continue to steadily rise, its perils, along with those of its fellow traveler, the metabolic syndrome, have arrived at our clinics and hospital wards in full force. The hazardous triad of the metabolic syndrome—hypertension, dyslipidemia and insulin resistance—were formerly considered to be medical issues that rested solely within the purview of the endocrinologist or the cardiologist. Rheumatologists were preoccupied with other pressing matters, such as dealing with the active inflammation that was steadily destroying our patients’ joints and damaging other critical tissues.