Key Points ÎIndividuals at high metabolic risk often have:
1) Elevations of apolipoprotein B (apo B)-containing lipoproteins [low-density lipoprotein (LDL) and very-low-density lipoprotein (VLDL)] with elevated triglycerides
2) Reduced levels of high-density lipoprotein cholesterol (HDL-C) 3) Increased plasma glucose levels 4) Hypertension 5) Enlarged waist circumference 6) A prothrombotic state 7) A proinflammatory state
ÎLifestyle management should be considered first-line therapy for patients at increased metabolic risk.
ÎPrimary prevention prevents diseases in those who do not yet have them. (Secondary prevention prevents complications of diagnosed diseases.)
Screening and Risk Assessment The Endocrine Society recommends:
ÎRegular screening (1⎟ ⊕⊕⊕), at least every 3 years for one or more risk factors (1⎟ ⊕) and yearly for prediabetes (IGT or IFG) (2⎟ ⊕), that includes blood pressure, waist circumference, BMI, fasting lipid profile, and fasting glucose.
ÎAll at-risk patients undergo global 10-year risk assessment by either the Framingham or the Prospective Cardiovascular Munster (PROCAM) scoring (online calculators available at: http://www.kardiolab.ch/MONICA- PROCAM3_RA1.html) or the European SCORE algorithm (1⎟ ⊕).
ÎTreatment goals for apo B-containing lipoproteins be based on 10-year risk assessment (see Table 3).
