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

...iagnosi...

...initions and Diag...

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

...dividuals aged 40–75 years in the office...

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

...: In individuals previously diagno...

...ends that all individuals at metabolic risk in the...

...dividuals with elevated blood pressure >130...

Table 1. Criteria Proposed for Clinical...

...1. Flow Chart for the Assessment and Treatment o...

...gure 2. Measuring Waist Circumference Accord...

...nded Waist Thresholds to Define Abdo...

.... Definitions of Prediabetes (Inte...


Treatment

...eatment

...estyle and Behavioral Therap...

...iduals at metabolic risk, ES recommends...

...duals at metabolic risk with excess weight (def...

...iduals at metabolic risk, ES recommends...

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

.... Effect of Lifestyle Components on Metabol...

...Components of Healthy Cardiovascular Diet...

...t Action Nutrient Action LDL-C...


...cal and Pharmacological The...

...Assessment and Evaluation...

...als identified as having metabolic ri...

...ndividuals with low density lipopro...

...olesterol Reduction

...dividuals 40–75 years of age with LDL-C â‰...

...individuals 40–75 years of age with LDL...

...n individuals 40–75 years of age withou...

...2: In individuals 40–75 years of age withou...

...3: In individuals with metabolic ris...

...viduals aged >75 years without diabetes a...

...viduals at metabolic risk who are taking statin...

...iduals aged 40 years and older at metabo...

...able 7. Statin TherapyHaving trouble view...

...ent Recommendations and LDL-C Goals for TreatmentH...

...od Pressure Reduction...

...7: In individuals with blood pressure ab...

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

...ucing Progression to Type 2 Di...

...ndividuals with prediabetes, ES rec...

...0: In individuals with prediabetes who have limit...