Primary Prevention of ASCVD and T2DM in Patients at Metabolic Risk

Last updated April 8, 2022

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...

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

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

1.3: To establish metabolic risk in the gene...

...4: In individuals previously diagnosed with predi...

...ds that all individuals at metabolic risk in the o...

...r individuals with elevated blood pressur...

.... Criteria Proposed for Clinical Diagnosis of...

...hart for the Assessment and Treatment of Metab...

...asuring Waist Circumference According to NHANE...

...mmended Waist Thresholds to Define Abdomin...

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


Treatment

...Trea...

...Lifestyle...

...individuals at metabolic risk, ES recommends th...

...individuals at metabolic risk with excess wei...

...als at metabolic risk, ES recommends prescribing...

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

...Effect of Lifestyle Components on Meta...

...onents of Healthy Cardiovascular Dietary Pa...

...nt Action Nutrient Action...


...Medical and Ph...

...Risk...

...dividuals identified as having metabolic risk...

...viduals with low density lipoprotein-ch...

...Ch...

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

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

...individuals 40–75 years of age without diab...

...iduals 40–75 years of age without diabete...

...iduals with metabolic risk, without di...

...dividuals aged >75 years without diabetes...

...individuals at metabolic risk who are ta...

...dividuals aged 40 years and older at me...

...Therapy Intensity De...

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

...Blood Pressure...

...viduals with blood pressure above 130...

...In individuals without a history of ASCVD...

...Reducing Progression to...

3.9: In individuals with prediabetes...

...viduals with prediabetes who have limitations t...