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J Clin Endocrinol Metab. 2019 Jul 31. pii: jc.2019-01338. doi: 10.1210/jc.2019-01338. [Epub ahead of print]

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

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Hebrew Rehabilitation Hospital, Boston, Massachusetts.
University of Chicago Medicine, Chicago, Illinois.
University of California Davis, Sacramento, California.
Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, Massachusetts.
Harvard Medical School, Boston, Massachusetts.
Johns Hopkins University School of Medicine, Baltimore, Maryland.
Evidence-Based Practice Center, Mayo Clinic, Rochester, Minnesota.
Centre Hospitalier Universitaire Dijon Bourgogne, Dijon, France.



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.


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 heart-healthy dietary pattern and sodium restriction, 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 aim for loss of ≥5% of initial body weight in the first year. Behavior changes should be supported by a comprehensive program led by trained interventionists and reinforced by primary care providers. Pharmacological and medical therapy can be used in addition to lifestyle modification when recommended goals are not achieved.


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