Endocrine Society recently published new guidelines on metabolic risk. Metabolic risk is characterized similarly to metabolic syndrome (syndrome X) but with the name change to emphasize action rather than description. Presence of three or more of the following entities defines high metabolic risk: high blood pressure, high glucose, high triglycerides, low HDLc, and increased waist circumference.
Although guidelines are similar to those of other national association such as ACC/AHA, ADA, AACE, and NLA; they introduce or emphasize the following elements:
- Should measure waist circumference routinely.
- Include A1c in the definition of metabolic risk (vs. fasting glucose only).
- Be more aggressive in using statin therapy for primary prevention.
- Can add fenofibrate rather than ezetimibe if triglycerides are above 200 mg/dL and HDLc is low.
These guidelines are essential as they further raise awareness of the real cardiovascular and diabetes risk associated with metabolic syndrome, and more importantly encouraging providers to act upon it.
I anticipate elaboration and incorporation of the above critical changes in other national guidelines. Prevention, always first.