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Endocrine Society: Most adults should be screened for metabolic risk
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Health care providers should regularly screen adults aged 40 to 75 years for all five components of metabolic risk to help detect atherosclerotic cardiovascular disease and type 2 diabetes earlier, according to a clinical practice guideline issued Wednesday by the Endocrine Society.
The updated guideline recommends measurements of waist circumference, blood pressure, triglycerides, LDL cholesterol and blood glucose during clinical visits. Individuals with at least three metabolic syndrome risk components should be considered at elevated metabolic risk, and should undergo 10-year global risk assessment for atherosclerotic CVD or coronary artery disease to determine targets of therapy for reduction of apolipoprotein B-containing lipoproteins, according to the guideline.
“The dramatic increase in the prevalence of individuals at risk for the development of atherosclerotic CVD and type 2 diabetes throughout the developed and developing world requires that physicians and other care providers are aware of the risk factors for these conditions and can identify individuals at risk to initiate treatment to prevent these diseases,” James L. Rosenzweig, MD, of Hebrew Rehabilitation Hospital in Boston and chair of the guideline writing committee, and colleagues wrote in the guideline. “The Endocrine Society has recognized the importance of identifying individuals who are at metabolic risk so that efforts can be instituted to prevent both [atherosclerotic] CVD and [type 2 diabetes].”
The guideline, according to the authors, addresses individuals with components of metabolic syndrome who do not yet have diagnosed atherosclerotic CVD or type 2 diabetes and the steps that can be taken to prevent these two diseases. It also focuses on behavioral, nutritional and medical management.
The guideline recommends screening patients with three or more risk factors regularly and screening patients with one or two risk factors every 3 years. This is in addition to assessing risk factors for CVD, including cholesterol levels, smoking and family history.
The guideline focuses on adults aged 40 to 75 but can be applied to patients outside of this age range, according to the authors.
“Doctors haven’t been doing enough to measure waist circumference, but it’s essential to identifying patients at metabolic risk earlier and preventing more cases of heart disease and diabetes,” Rosenzweig said in a press release. “We emphasize the importance of lifestyle, dietary and behavioral changes as the first-line treatment. However, treatment with medication is appropriate if goals are not met with lifestyle changes alone.”
The guideline recommends:
- Measuring waist circumference as a routine part of the clinical examination;
- Checking blood pressure annually, and, if elevated, at each subsequent visit;
- Prioritizing lifestyle modification as first-line therapy;
- Aiming to lose 5% or more of initial body weight over the first year for individuals at metabolic risk with excess weight;
- Undergoing a 10-year global risk assessment for coronary artery disease or atherosclerotic CVD to guide the use of medical or pharmacological therapy; and
- Prescribing lifestyle modification before drug therapy for patients with prediabetes to reduce blood sugar levels.
The authors also recommend that individuals with prediabetes be screened for diabetes at least yearly.
“Growing evidence indicates that many individuals who develop [atherosclerotic] CVD or [type 2 diabetes] have common antecedents of metabolic origin,” the researchers wrote. “Although the pathophysiology underlying these antecedents is not fully understood, there is a strong overlap between cardiovascular risk factors and prediabetes in its various definitions (impaired fasting glucose, impaired glucose tolerance, or at risk for diabetes with HbA1c above normal). Accordingly, identification of a general condition called ‘metabolic risk’ is reasonable.”
The American Diabetes Association and the European Society of Endocrinology co-sponsored the guideline. – by Regina Schaffer
Disclosures: Rosenzweig reports he receives organizational financial compensation from Bayer and Novo Nordisk. Please see the guideline for all other authors’ relevant financial disclosures.
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Rosenzweig JL, et al. J Clin Endocrinol Metab. 2019;doi:10.1210/jc.2019-01338.
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