Primary Prevention of ASCVD and T2DM in Patients at Metabolic Risk: An Endocrine Society*Clinical Practice Guideline

Objective: To develop clinical practice guidelines for the primary prevention of atherosclerotic cardiovascular disease (ASCVD) and type 2 diabetes mellitus (T2DM) in individuals at metabolic risk for developing these conditions. Conclusions: Health care providers should incorporate regular screening and identification of individuals at metabolic risk (at higher risk for ASCVD and T2DM) with measurement of blood pressure, waist circumference, fasting lipid profile, and blood glucose. Individuals identified at metabolic risk should undergo 10-year global risk assessment for ASCVD or coronary heart disease to determine targets of therapy for reduction of apolipoprotein B-containing lipoproteins. Hypertension should be treated to targets outlined in this guideline. Individuals with prediabetes should be tested at least annually for progression to diabetes and referred to intensive diet and physical activity behavioral counseling programs. For the primary prevention of ASCVD and T2DM, the Writing Committee recommends lifestyle management be the first priority. Behavioral programs should include a hearthealthy dietary pattern and sodiumrestriction, as well as an active lifestyle with daily walking, limited sedentary time, and a structured program of physical activity, if appropriate. Individuals with excess weight should aimfor loss of $5%of initial body weight in the first year. Behavior changes should be supported by a comprehensive programled by trained interventionists and reinforced by primary care providers. Pharmacological andmedical therapy can be used in addition to lifestylemodification when recommended goals are not achieved.