{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T12:07:43Z","timestamp":1789387663023,"version":"build-2803163510"},"reference-count":54,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T00:00:00Z","timestamp":1789344000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:p>Cardiometabolic diseases\u2014principally cardiovascular disease, type 2 diabetes, and obesity\u2014remain leading global drivers of premature mortality, disability, and healthcare expenditure, despite substantial advances in their biological understanding, risk assessment, and treatment. This narrative review critically examines why increasingly effective preventive interventions have failed to yield a commensurate reduction in population-level disease burden, identifying the biological, clinical, organizational, economic, and social factors that sustain this evidence-to-practice gap. It integrates evidence across three complementary dimensions: (1) The biological continuum, linking metabolic dysfunction, chronic low-grade inflammation, and cumulative exposure to apolipoprotein B (ApoB)-containing lipoproteins with atherosclerotic cardiovascular disease; (2) The clinical continuum, extending from early risk recognition and targeted diagnostic evaluation to individualized intervention and longitudinal reassessment; and (3) The organizational continuum, required to deliver coordinated, multidisciplinary prevention across health systems. Particular attention is given to total and lifetime cardiovascular risk, the clinical application and limitations of SCORE2 and SCORE2-OP, and the diagnostic challenges of identifying younger or apparently healthy individuals whose low short-term risk masks significant cumulative lifetime exposure. The review critically evaluates the causal role and clinical interpretation of ApoB-containing lipoproteins, including lipoprotein(a) [Lp(a)], and the complementary role of emerging biomarkers and subclinical atherosclerosis imaging, while carefully distinguishing enhanced risk prediction from demonstrated improvements in hard clinical outcomes. An educational and translational clinical vignette illustrates how the longitudinal interpretation of routine clinical and laboratory data supports proportionate assessment of persistent dyslipidemia, treatment response, and plausible primary and secondary contributors to cardiometabolic risk well before symptom onset. Rather than attributing borderline abnormalities to a single occult disorder, the vignette demonstrates how standardized confirmation, verification of medication exposure, etiological assessment, targeted referral, and structured reassessment can translate routine data into actionable preventive pathways. Ultimately, this analysis indicates that cardiometabolic prevention is constrained less by a lack of scientific evidence or effective pharmacotherapies than by delayed risk recognition, therapeutic inertia, poor treatment adherence, fragmented care pathways, limited multidisciplinary coordination, structural health inequalities, and the incomplete integration of clinical, laboratory, behavioral, environmental, and patient-reported data. Improving outcomes therefore demands a systemic shift from episodic, disease-specific management toward early, lifelong, proportionate, coordinated, equitable, and patient-centered cardiometabolic prevention\u2014underpinned by implementation science, precision prevention, digital health solutions, health-economic evaluations, patient-reported outcome measures (PROMs), and patient-reported experience measures (PREMs).<\/jats:p>","DOI":"10.3389\/fpubh.2026.1903747","type":"journal-article","created":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T12:01:26Z","timestamp":1789387286000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Bridging the evidence-to-practice gap in cardiometabolic prevention: from episodic care to lifelong, system-wide responsibility"],"prefix":"10.3389","volume":"14","author":[{"given":"Wirginia","family":"Krzy\u015bciak","sequence":"first","affiliation":[{"name":"Department of Medical Diagnostic, Faculty of Pharmacy, Jagiellonian University Medical College","place":["Krak\u00f3w, Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pawe\u0142","family":"Latacz","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery and Angiology, St. John Grande Hospital","place":["Krak\u00f3w, Poland"]},{"name":"Department of Radiology, Faculty of Medicine, Jagiellonian University Medical College","place":["Krak\u00f3w, Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maciej","family":"Chwa\u0142a","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery and Angiology, St. John Grande Hospital","place":["Krak\u00f3w, Poland"]},{"name":"Clinic of Surgery, Institute of Physiotherapy, Jagiellonian University Medical College","place":["Krak\u00f3w, Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Lizo\u0144","sequence":"additional","affiliation":[{"name":"Department of Medical Diagnostic, Faculty of Pharmacy, Jagiellonian University Medical College","place":["Krak\u00f3w, Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ma\u0142gorzata","family":"Trofimiuk-M\u00fcldner","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Faculty of Medicine, Jagiellonian University Medical College","place":["Krak\u00f3w, Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,14]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"106","DOI":"10.1186\/s12982-025-00496-8","article-title":"Interconnected epidemics: obesity, metabolic syndrome, diabetes and cardiovascular diseases\u2014insights from research and prevention strategies","volume":"22","author":"Gupta","year":"2025","journal-title":"Discov Public Health"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"e1533","DOI":"10.1016\/S2214-109X(25)00237-2","article-title":"Prediabetes transitions to normoglycaemia or type 2 diabetes and associated risk factors in the obesity, diabetes and cardiovascular disease collaboration: an individual-level pooled analysis of 19 prospective cohort studies","volume":"13","author":"Davoodian","year":"2025","journal-title":"Lancet Glob Health"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"2982","DOI":"10.1016\/j.jacc.2020.11.010","article-title":"Global burden of cardiovascular diseases and risk factors, 1990\u20132019: update from the GBD 2019 study","volume":"76","author":"Roth","year":"2020","journal-title":"J Am Coll Cardiol"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"426","DOI":"10.1016\/S2213-8587(23)00086-4","article-title":"Metabolic health and cardiometabolic risk clusters: implications for prediction, prevention, and treatment","volume":"11","author":"Stefan","year":"2023","journal-title":"Lancet Diabetes Endocrinol"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"860","DOI":"10.1038\/nature05485","article-title":"Inflammation and metabolic disorders","volume":"444","author":"Hotamisligil","year":"2006","journal-title":"Nature"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1057","DOI":"10.2337\/dci24-0094","article-title":"Metabolic dysfunction-associated steatotic liver disease (MASLD) in people with diabetes: the need for screening and early intervention. 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