Primary Prevention of ASCVD and T2DM in Patients at Metabolic Risk

Publication Date: July 31, 2019

Key Points

Key Points

Individuals should be screened for metabolic risk, in five categories:
  • Elevated waist circumference
  • Decreased high density lipoprotein (HDL) cholesterol
  • Elevated serum triglycerides
  • Elevated blood pressure
  • Elevated blood glucose
Three or more categories being abnormal should alert the clinician to a patient’s increased risk for atherosclerotic cardiovascular disease (ASCVD) and type 2 diabetes mellitus (T2DM) (i.e., metabolic risk).

Endocrine Society (ES) recommends that providers measure waist circumference as part of the initial evaluation. (Note: However, that this does not replace the measurement of weight.)

Behavioral change should be the first-line therapy for prevention and should include changes to diet, increased exercise, and weight loss.

Persons identified as having metabolic risk should undergo risk scoring to identify the 10-year risk for ASCVD.

Diagnosis

...Diagnosis...

...Definitions and D...

...1: In individuals aged 40–75 years in the...

...uals aged 40–75 years in the office setti...

...ish metabolic risk in the general population, E...

...dividuals previously diagnosed wit...

...S recommends that all individuals at metabolic...

....6: For individuals with elevated blo...

...iteria Proposed for Clinical Diagnosis of the M...

...e 1. Flow Chart for the Assessment and Treatmen...

...gure 2. Measuring Waist Circumfere...

...able 2. Recommended Waist Thresholds...

...nitions of Prediabetes (Intermediate Gly...


Treatment

...Tr...

...Lifestyle a...

...In individuals at metabolic risk, ES recommend...

...iduals at metabolic risk with excess weight (d...

...3: In individuals at metabolic risk, ES re...

...dividuals at metabolic risk, ES recommends p...

...Effect of Lifestyle Components on Me...

Table 5. Components of Healthy Cardiovasc...

...e 6. Nutrient Action Nutrient Acti...


...Medical and Phar...

...Risk As...

...ividuals identified as having metabolic ri...

...individuals with low density lipopr...

...Cholest...

...uals 40–75 years of age with LDL-C ≥190...

...als 40–75 years of age with LDL-C 70–189 mg/dL...

3.4.1: In individuals 40–75 years of age...

...In individuals 40–75 years of age w...

...3: In individuals with metabolic risk, without d...

....4: In individuals aged >75 years without diab...

...uals at metabolic risk who are taking statins...

...In individuals aged 40 years and older at metab...

...7. Statin TherapyHaving trouble viewing...

...atment Recommendations and LDL-C Goals for T...

...Blood Pressure...

...uals with blood pressure above 130/80 mmHg and a t...

...ndividuals without a history of ASCVD wit...

...Red...

...iduals with prediabetes, ES recommends prescribing...

...individuals with prediabetes who have limitations...