Dr KK Aggarwal
A new guideline from the Endocrine Society recommends measuring additional five markers of metabolic risk - waistline, blood pressure, HDL cholesterol, blood fats and blood sugar during consultation for earlier detection of heart disease and diabetes in adults aged 40 to 75.
The five risk factors for heart disease and diabetes are:
· large amount of abdominal body fat
· low HDL (“good”) cholesterol
· high triglycerides
· high blood pressure
· high blood sugar
Patients with at least 3 of these factors are at metabolic risk (higher risk for heart disease and diabetes) and should be screened regularly.
Patients with one or two risk factors should be screened every 3 years.
This is in addition to assessing risk factors for cardiovascular disease like “bad” cholesterol, smoking and family history.
Key recommendations from the guideline
· Measure waist circumference routinely as part of the clinical examination.
· Check blood pressure annually, and, if elevated, at each subsequent visit.
· Prioritize lifestyle modification as the first-line therapy.
· Aim to lose 5% or more of initial body weight over the first year for individuals at metabolic risk with excess weight.
· Individuals identified at metabolic risk should undergo a 10-year global risk assessment for either coronary heart disease or atherosclerotic cardiovascular disease (ASCVD) to guide the use of medical or pharmacological therapy.
· Prescribe lifestyle modification before drug therapy in patients with prediabetes to reduce blood sugar levels; they should be tested at least annually for progression to diabetes
The guideline was published online July 31, 2019 in The Journal of Clinical Endocrinology & Metabolism.
Padma Shri Awardee
President Elect Confederation of Medical Associations in Asia and Oceania (CMAAO)
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India