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Lipid Management in Endocrine Disorders

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Obesity 11 5. Obesity ➤ 5.1 In individuals who have obesity, we advise assessment of components of the metabolic syndrome (MetS) and body fat distribution to accurately determine the level of CVD risk. (UGPS) Technical Remarks: ▶ Diagnosis of MetS requires the presence of three of the following criteria: > Elevated TG ≥150 mg/dL (1.7 mmol/L) or on TG-lowering medication > Reduced HDL-C <50 mg/dL (1.3 mmol/L) in women and <40 mg/dL (1.0 mmol/L) in men. > Systolic blood pressure ≥ 130 mm Hg or diastolic blood pressure ≥85 mm Hg or on blood pressure medication. > Elevated waist circumference (men ≥40 in [102 cm] and women ≥35 in [88 cm]), except for East and South Asian men ≥35 in (90 cm) and women ≥31.5 in (80 cm). > Hyperglycemia (but not yet with T2D) is defined by cutoffs for prediabetes according to fasting blood glucose, oral glucose tolerance and/or HbA1c. ▶ Body fat distribution can be assessed in clinical practice by measuring the waist size or the waist/hip ratio. ▶ Waist size measurement in people with body mass index greater than 35 kg/m 2 has potential limitations. ➤ 5.2 In individuals who have obesity, we suggest lifestyle measures as first-line treatment to reduce plasma TG to lower CV and pancreatitis risk. (2|⊕ ) Technical Remarks: ▶ Reductions in LDL-C and increases in HDL-C are modest compared to the decrease in TG with lifestyle measures that produce weight loss. ▶ Lifestyle therapy-induced changes in the lipid profile in obesity have not been shown to reduce CVD events. ➤ 5.3 In individuals who have obesity, we recommend assessment of 10-year risk for ASCVD to guide the use of lipid-lowering therapy. (1|⊕⊕⊕ ) Technical Remarks: ▶ Calculation of 10-year risk for ASCVD may be done using the Pooled Cohort Equations. ▶ Elevated LDL-C is predictive of CV risk.

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