Rosenzweig James L, Bakris George L, Berglund Lars F, Hivert Marie-France, Horton Edward S, Kalyani Rita R, Murad M Hassan, Vergès Bruno L
Hebrew Rehabilitation Hospital, Boston, Massachusetts.
University of Chicago Medicine, Chicago, Illinois.
J Clin Endocrinol Metab. 2019 Sep 1;104(9):3939-3985. doi: 10.1210/jc.2019-01338.
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.
制定针对有发生动脉粥样硬化性心血管疾病（ASCVD）和2型糖尿病（T2DM）代谢风险个体的一级预防临床实践指南。
医疗保健提供者应纳入对有代谢风险（ASCVD和T2DM风险较高）个体的定期筛查和识别，测量血压、腰围、空腹血脂谱和血糖。已识别有代谢风险的个体应接受ASCVD或冠心病的10年全球风险评估，以确定降低含载脂蛋白B脂蛋白的治疗目标。高血压应按照本指南概述的目标进行治疗。糖尿病前期个体应至少每年检测是否进展为糖尿病，并转诊至强化饮食和身体活动行为咨询项目。对于ASCVD和T2DM的一级预防，写作委员会建议生活方式管理为首要任务。行为项目应包括有益心脏健康的饮食模式和钠限制，以及积极的生活方式，如每日步行、减少久坐时间，并酌情进行结构化的体育活动项目。超重个体应在第一年目标是减轻初始体重的≥5%。行为改变应由经过培训的干预人员主导的综合项目提供支持，并由初级保健提供者强化。当未实现推荐目标时，除生活方式改变外，可使用药物和医学治疗。
