Metabolic Risk Guideline Resources

Full Guideline: Primary Prevention of ASCVD and T2DM in Patients at Metabolic Risk
JCEM | September 2019 (online July 2019)

James L. Rosenzweig (chair), George L. Bakris, Lars F. Berglund, Marie-France Hivert, Edward S. Horton, Rita R. Kalyani, M. Hassan Murad, Bruno L. Vergès

The 2019 guideline on metabolic risk:

  • Updates the previous recommendations on this topic from the 2008 guideline – particularly those on elevated lipids and blood pressure – to reflect more recent data.
  • Emphasizes measures to identify and reduce the risk of ASCVD and T2DM, rather than defining the metabolic syndrome as a clinical entity.
  • Focuses on adults between 40 and 75 years of age, for whom a higher quality of evidence exists than for other age groups, thus accruing the greatest impact.

Systematic Review


Essential Points

  • Individuals should be screened for metabolic risk, in five categories:
    1. Elevated waist circumference
    2. Decreased HDL cholesterol
    3. Elevated serum triglycerides
    4. Elevated blood pressure
    5. Elevated blood glucose
  • Three or more categories being abnormal should alert the clinician to a patient’s increased risk for ASCVD and DM (i.e., metabolic risk).
  • We recommend 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.

List of Recommendations

+ 1.0 Definitions and Diagnosis

+ 2.0 Lifestyle and Behavioral Therapy

+ 3.0 Medical and Pharmacological Therapy