Endocrine News talks with James Rosenzweig, MD, chair of the task force that developed the latest Endocrine Society Clinical Practice Guideline on Preventing Cardiovascular Disease and Type 2 Diabetes in Patients at Metabolic Risk.
A new Endocrine Society clinical practice guideline states that measuring waistline, blood pressure, cholesterol, and blood sugar during doctor’s visits could possibly play a role in preventing heart disease and diabetes.
“Primary Prevention of CVD and T2DM in Patients at Metabolic Risk: An Endocrine Society Clinical Practice Guideline,” was published online and will appear in the September 2019 print issue of The Journal of Clinical Endocrinology & Metabolism, more than a decade after the original guideline was published in 2008. This revised version offers a new take on metabolic risk and presents recommendations which reflect more recent trial data on blood pressure and lipids. The guideline prioritizes lifestyle and behavioral interventions and discusses new medical treatment options. Although the recommendations target patients aged 40 to 75, it can be used for patients at other ages as well.
James L. Rosenzweig, MD, of the Hebrew Rehabilitation Hospital in Boston, Mass., chaired the writing committee that developed the guideline and says that measuring the waistline during doctor’s visits can often help clinicians spot patients at metabolic risk earlier and prevent more cases of heart disease and diabetes. “We emphasize the importance of lifestyle, dietary and behavioral changes as the first line treatment,” he says. “However, treatment with medication is appropriate if goals are not met with lifestyle changes alone.”
Rosenzweig shares his thoughts with Endocrine News about how this new guideline will emphasize advances in treatment, as well as the importance of various lifestyle and behavioral aspects, all of which contribute to improved metabolic health in these patients.
ENDOCRINE NEWS: What was the main reason for the development of a guideline on treating patients at metabolic risk? What drove the decision and why now?
JAMES ROSENZWEIG: There has been a dramatic increase in people at risk for developing atherosclerotic cardiovascular disease and type 2 diabetes in both the developed and developing world. This is a growing public health problem which needs to be addressed by medical providers. The risk factors for these two conditions tend to cluster together in many patients, so common interventions can reduce risk for both conditions and increase longevity and quality of life.
The term “metabolic syndrome” has been used to describe these clustered risk factors, which include obesity, high blood pressure, elevated triglycerides, low HDL “good” cholesterol, and abnormal elevation of blood sugar. Our definition of metabolic risk in this guideline includes those people with the metabolic syndrome who do not yet have either cardiovascular disease or diabetes but are at increased risk for both conditions.
This Endocrine Society Guideline was originally published in 2008, and it has been revised and updated to reflect our more current knowledge of the benefits of lifestyle and behavioral interventions and new options for medical treatment. We focus on persons age 40 to 75, for whom the supporting evidence is highest, for whom prevention is most critical, and interventions can have the greatest impact.
However, our recommendations can be used to help guide health care decisions in patients outside of this age range.
“Our definition of metabolic risk in this guideline includes those people with the metabolic syndrome who do not yet have either cardiovascular disease or diabetes but are at increased risk for both conditions.”
EN: What impact do you anticipate the guideline recommendations will make on endocrine standards of care of patients at metabolic risk?
JR: The focus is on early assessment and prevention. Measurement of waist circumference can improve our identification of risk. We emphasize the importance of lifestyle, dietary and behavioral changes as the first line of action for prevention of atherosclerotic cardiovascular disease. Treatment with medications is to be used if the goals are not met with behavioral interventions.
EN: How do you see the guideline influencing medical specialties other than endocrinology?
JR: Endocrinologists tend to see patients after they have already developed diabetes and its complications. The healthcare providers that can be most influenced by our recommendations are in primary care, general internal medicine, and geriatrics.
“We focus on persons age 40 to 75, for whom the supporting evidence is highest, for whom prevention is most critical, and interventions can have the greatest impact.”
EN: What are the key take home messages for patients in this guideline?
JR: You can reduce your risk of getting heart disease and diabetes with a healthy food choices and exercise. Your doctor can help identify your risk by checking your waist circumference, blood pressure, lipid profile, and blood glucose. Medications can be added for improvement of these risk factors if your diet and behavior efforts are not able to reach the appropriate targets.