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By searching for five simple markers: height, height, blood pressure, HDL cholesterol, triglycerides and glucose / HbA1 C – During office visits, clinicians could identify high-risk adults who need to improve their lifestyle to prevent cardiovascular disease or type 2 diabetes.
This is the main message of a new clinical practice guideline entitled "Primary prevention of ASCVD and T2DM in patients with metabolic risk" – published by the Society of Endocrinology and published online July 31 in the Journal of Clinical Endocrinology and Metabolism.
"Doctors have not done enough to measure waist circumference, but it is critical to identify earlier patients at metabolic risk and prevent further heart disease and diabetes," said the Committee Chair, James L. Rosenzweig, MD, Hebrew Rehabilitation Hospital, Boston, Mbad., said in a statement issued by the Endocrine Society.
"We highlight the importance of lifestyle, diet and behavior changes as a first-line treatment," Rosenzweig said. "However, drug treatment is appropriate if the goals are not achieved solely with lifestyle changes."
Do physical activity, reduce sedentary time, lose 5% of weight
The new directive, co-sponsored by the American Diabetes Association and the European Society of Endocrinology, is aimed at primary health care providers, endocrinologists, geriatricians and cardiologists.
"People aged 40 to 75 occupying an office," says the report, "we suggest providers screen for the five components of metabolic risk during the clinical visit."
The discovery "at least three components should specifically alert the clinician to a patient at metabolic risk (at increased risk of atherosclerotic cardiovascular disease and type 2 diabetes)," the report says.
Although evidence suggests that patients 40 to 70 years of age would benefit the most, other patients, particularly the younger ones, could also benefit from early identification of the risk of heart disease and diabetes mellitus. altering their diet and exercise habits to alleviate them. , add the guideline writers.
The five risk factors are:
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High blood pressure
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Increase in waist circumference
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High fasting triglycerides
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Low HDL cholesterol
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High blood sugar
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HbA1 C ≥5.7% to 6.4%, or
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Fasting blood glucose ≥ 100 mg / dL (≥ 5.6 mmol / L)
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Patients with three or more risk factors should be screened regularly, and those with one or two risk factors should be screened every three years.
Clinicians should also screen for cholesterol, smoking, and family history of cardiovascular disease.
And they "should begin discussions on the importance of adopting a healthy lifestyle with all people at metabolic risk," say the authors.
In addition to regularly measuring weight and height and calculating the body mbad index, clinicians also need to measure the size of the patient's height.
They should check the patient's blood pressure every year and, if it is high, repeat the measurement another day or have it checked with the help of a home blood pressure monitor.
"We recommend that people with metabolic risk prescribe daily physical activity, such as brisk walking and reduced sedentary time," and encourage overweight patients to lose 5% of their weight over time. the next year, says the recommendation.
Statin therapy should be prescribed on a case-by-case basis as needed.
Updates tips older tips 2008
The previous version of the guidelines had been published in 2008; the current guidelines have been updated with new data.
For example, the new directive
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Focuses on measures to identify and reduce the risk of atherosclerotic cardiovascular disease and type 2 diabetes, rather than defining the metabolic syndrome as a clinical entity
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Is more focused on adults aged 40 to 75
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Includes HbA1 C as a measure of blood sugar
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Recommends annual screening for diabetes in prediabetic patients
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Includes cohort equation from the American Heart Association / American College of Cardiology to calculate 10-year risk of atherosclerotic disease
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Defines the risk of atherosclerotic disease over 10 years as moderate if it is between 5% and 7.5% (instead of 10%) and high when it is> 7.5%
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Establishes a target blood pressure of 130/80 mmHg (as opposed to 140/90 mmHg) based on the evaluation data of the prevention of cardiac consequences-3 (HOPE 3), Evaluation of Diabetes Reduction with the drug Ramipril and Rosiglitazone (DREAM), and antihypertensive and lipid-lowering therapy to prevent heart attacks (ALLHAT)
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No longer recommends aspirin in this population because of a lack of evidence of benefit and risk of bleeding
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Updates the recommendations for a diet and exercise based on more recent data
"This review takes a fresh look at the metabolic risk and presents recommendations that reflect more recent testing data on blood pressure and lipids," says the Endocrinology Society. In addition, it "prioritizes lifestyle and behavioral interventions and addresses new options for medical treatment".
J Clin Endocrinol Metab. Posted online July 31, 2019.
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