Table.

Causes of and potential remedies for “disastrous cardio-metabolic risk factors”

Categories	Issues That Could Worsen CMRF Control	Potential Strategies That Could Help Mitigate The Issues
Social factors	Financial hardships
	Additional job responsibilities and insecurities
	Reduced capacity for lifestyle management	Expand insurance coverage for remote consults to include non-physician-based health promotion and education (e.g. dietary and exercise therapies)
	Insurance coverage difficulties	Alternative insurance paradigms and expanded coverage systems (e.g., “medicare for all”) that are part of a larger debate might be helpful.
	Restricted available time for clinic visits	Expand non-traditional healthcare settings (e.g., barber shops, salons) in communities to improve access and proximity to care5
	Transportation and travel difficulties	Improving access and reducing costs of medical transportation. Use of non-traditional care settings. Use of telehealth and a dedicated remote “CMRF-control program”
	Decreased medication and lifestyle compliance	Involve proven methods to enhance persistence (e.g., mobile health platforms, text/call reminders)5
	Medication loss	Free home medication delivery, secure medication vending-machines. Increase the pool of independent prescribers (e.g., pharmacists)
Biological responses	Endothelial dysfunction	Improve CMRF control
	Chronic post-traumatic stress disorder	Expand insurance coverage for remote consults to also include counselling for psychological disorders by physicians and other mental health professionals
	Reduced sleep duration/quality (circadian disruption)	Expand insurance coverage for remote consults to also include counselling and medication therapy for sleep disorders when appropriate
	SNS and HPAA activation	Use of anti-SNS medications (e.g., beta blockers or clonidine) when appropriate.
	Poor diet - alcohol abuse, increased dietary sodium	Expand insurance coverage for remote consults to also include dieticians
	Weight gain, inactivity	Expand insurance coverage for remote consults to also include dieticians and exercise therapists
Healthcare system failures	Reduced medication availability	Adequate stock-pile of “essential” cardiovascular medications (e.g., statins, BP medications)
	Reduced clinic space and time availability	Telemedicine and non-traditional settings of care Use a dedicated remote “CMRF-control program”
	Fewer health care providers and reduced availability	Telemedicine and non-traditional settings of care Use a dedicated remote “CMRF-control program”
	Decrease in medical resources and equipment	Telemedicine and non-traditional settings of care Use a dedicated remote “CMRF-control program”
	Prioritization of care to urgent health issues	Education of the importance of “disastrous CMRFs” to healthcare providers and patients. Use a dedicated remote “CMRF-control program”
	Down-playing continued importance of CMRF control by providers	Education of the importance of “disastrous CMRFs” to healthcare providers and patients. Use a dedicated remote “CMRF-control program”

BP, blood pressure; CMRF, cardio-metabolic risk factors; HPAA, hypothalamic-pituitary-adrenal axis; SNS, sympathetic nervous system