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

...agnosis...

...initions and Diag...

...individuals aged 40–75 years in the office sett...

...individuals aged 40–75 years in t...

...ish metabolic risk in the general p...

...viduals previously diagnosed with prediabete...

...S recommends that all individuals at me...

...dividuals with elevated blood pressure >1...

...ria Proposed for Clinical Diagnosis of the Metabo...

...ure 1. Flow Chart for the Assessment an...

...Measuring Waist Circumference According...

...ended Waist Thresholds to Define Abdomina...

...3. Definitions of Prediabetes (Intermedi...


Treatment

...eatmen...

...ifestyle and Behavioral...

...n individuals at metabolic risk, ES rec...

...ndividuals at metabolic risk with excess weigh...

...n individuals at metabolic risk, ES reco...

...individuals at metabolic risk, ES recomm...

...of Lifestyle Components on Metabolic Par...

...nts of Healthy Cardiovascular Dietary Patte...

...trient Action Nutrient Act...


...nd Pharmacological Therapy...

Risk Assessment and Evaluation...

...In individuals identified as having m...

...ividuals with low density lipoprotein...

...holesterol Reduction...

...duals 40–75 years of age with LDL-...

...4: In individuals 40–75 years of age with L...

...1: In individuals 40–75 years of ag...

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

...n individuals with metabolic risk, without diabete...

...In individuals aged >75 years without dia...

...In individuals at metabolic risk who are taking s...

...individuals aged 40 years and older at metabolic...

Table 7. Statin TherapyHaving trou...

Table 8. Treatment Recommendations and LDL-C...

...ood Pressure Reduction...

...In individuals with blood pressure above 1...

...ividuals without a history of ASCVD wi...

...ression to Type 2 Diabetes...

...iduals with prediabetes, ES recommends prescri...

...n individuals with prediabetes who have...