CardioMetabolic Health Alliance: Metabolic Syndrome Model
CardioMetabolic Health Alliance: Metabolic Syndrome Model
Think Tank (TT) participants reviewed concepts accepted by the medical community and supported in previous recommendations. Those affirmed concepts (ACs) presented here constitute a consensus, are consistent with the evidence base established at the TT, and are deemed to have sufficient potential benefit to warrant actionable recommendations.
AC.1.Metabolic syndrome (MetS) is a progressive pathophysiological state associated with substantially increased risk for development of type 2 diabetes (T2D) and atherosclerotic cardiovascular disease (ASCVD).
AC.2.MetS is clinically manifested by a cluster of risk factors that are causally inter-related (not aggregating by chance alone).
AC.3.Risk for adverse health outcomes increases substantially with accumulation of component MetS risk factors, in addition to unmeasured ("residual risk") factors. Timely recognition of MetS risk factors helps to identify individuals at high risk for ASCVD and T2D and to initiate preventive strategies before end-organ damage occurs.
AC.4.Obesity is a MetS risk factor that is imperfectly gauged by body mass index and/or waist circumference, and is modulated by adipocyte distribution, size, and function, as well as race, behavior, and lifestyle. Excess ectopic and/or visceral adiposity is fundamental to the pathophysiology of MetS.
AC.5.Treatment of MetS should prioritize therapeutic lifestyle changes, including a healthy diet and regular physical activity, to address all risk factors. Treatment should also continue to be focused on specific interventions for component MetS risk factors.
AC.6.The term "Metabolic Syndrome" will be used to designate a portfolio of descriptors that have previously included the terms cardiometabolic syndrome, insulin resistance syndrome, syndrome X, and others. TT participants concluded that MetS was the term most often used in the scientific published data and by health care professionals. Although arguments can be made for use of the other terms, the TT felt that trying to replace MetS would distract from its primary tasks.
New concepts emerged during the interdisciplinary discussions of the evidence base at the TT. These emergent concepts (ECs) require validation, but may have sufficient potential to generate actionable recommendations.
EC.1.MetS should be classified by subtype and stage, which translate to specific evidence-based management algorithms to improve clinical outcomes.
EC.2.Improved metrics to define high-risk obesity are needed and may be characterized by evidence-based assessments including, but not limited to, waist circumference, body composition, and imaging-based assessments of ectopic fat and/or visceral adipose tissue.
EC.3.Structured lifestyle interventions for residual risk reduction are required. Focused research and improved education on lifestyle medicine are also needed.
EC.4.Health care disparities need to be addressed with respect to: 1) access to structured lifestyle interventions; 2) integrated care delivery systems with enhanced provider awareness, accountability, and communication, along with tools to appropriately identify and treat those at risk; and 3) community engagement.
EC.5.New care models, such as the patient-centered medical home (PCMH) and Accountable Care Organizations (ACOs), are needed that incorporate new technology, electronic health records, and novel reimbursement paradigms.
After reviewing the affirmed and emergent concepts, the writing committee formulated 5 key findings (KFs).
KF.1.MetS is a cluster of risk factors, both formally defined and less well recognized, that increase the risk of certain diseases.
KF.2.The presence of ectopic fat and/or visceral adipose tissue is critical to the pathogenesis of MetS and may explain some of the variability in phenotypic presentation across racial groups.
KF.3.A new care model for patients with MetS is essential and should include screening, risk stratification, and algorithmic management of patients according to the specific subtype and stage.
KF.4.Structured lifestyle interventions are required to adequately treat MetS and reduce residual ASCVD risk.
KF.5.Implementation of a new patient care model should focus on integrated care delivery, alternative reimbursement strategies (perhaps utilizing the emerging constructs of the PCMH and ACO), and education that uses structured lifestyle intervention; optimal use of pharmaceuticals, including combination therapies; and appropriate consideration of surgery.
Executive Summary
Affirmed Concepts
Think Tank (TT) participants reviewed concepts accepted by the medical community and supported in previous recommendations. Those affirmed concepts (ACs) presented here constitute a consensus, are consistent with the evidence base established at the TT, and are deemed to have sufficient potential benefit to warrant actionable recommendations.
AC.1.Metabolic syndrome (MetS) is a progressive pathophysiological state associated with substantially increased risk for development of type 2 diabetes (T2D) and atherosclerotic cardiovascular disease (ASCVD).
AC.2.MetS is clinically manifested by a cluster of risk factors that are causally inter-related (not aggregating by chance alone).
AC.3.Risk for adverse health outcomes increases substantially with accumulation of component MetS risk factors, in addition to unmeasured ("residual risk") factors. Timely recognition of MetS risk factors helps to identify individuals at high risk for ASCVD and T2D and to initiate preventive strategies before end-organ damage occurs.
AC.4.Obesity is a MetS risk factor that is imperfectly gauged by body mass index and/or waist circumference, and is modulated by adipocyte distribution, size, and function, as well as race, behavior, and lifestyle. Excess ectopic and/or visceral adiposity is fundamental to the pathophysiology of MetS.
AC.5.Treatment of MetS should prioritize therapeutic lifestyle changes, including a healthy diet and regular physical activity, to address all risk factors. Treatment should also continue to be focused on specific interventions for component MetS risk factors.
AC.6.The term "Metabolic Syndrome" will be used to designate a portfolio of descriptors that have previously included the terms cardiometabolic syndrome, insulin resistance syndrome, syndrome X, and others. TT participants concluded that MetS was the term most often used in the scientific published data and by health care professionals. Although arguments can be made for use of the other terms, the TT felt that trying to replace MetS would distract from its primary tasks.
Emergent Concepts
New concepts emerged during the interdisciplinary discussions of the evidence base at the TT. These emergent concepts (ECs) require validation, but may have sufficient potential to generate actionable recommendations.
EC.1.MetS should be classified by subtype and stage, which translate to specific evidence-based management algorithms to improve clinical outcomes.
EC.2.Improved metrics to define high-risk obesity are needed and may be characterized by evidence-based assessments including, but not limited to, waist circumference, body composition, and imaging-based assessments of ectopic fat and/or visceral adipose tissue.
EC.3.Structured lifestyle interventions for residual risk reduction are required. Focused research and improved education on lifestyle medicine are also needed.
EC.4.Health care disparities need to be addressed with respect to: 1) access to structured lifestyle interventions; 2) integrated care delivery systems with enhanced provider awareness, accountability, and communication, along with tools to appropriately identify and treat those at risk; and 3) community engagement.
EC.5.New care models, such as the patient-centered medical home (PCMH) and Accountable Care Organizations (ACOs), are needed that incorporate new technology, electronic health records, and novel reimbursement paradigms.
Key Findings
After reviewing the affirmed and emergent concepts, the writing committee formulated 5 key findings (KFs).
KF.1.MetS is a cluster of risk factors, both formally defined and less well recognized, that increase the risk of certain diseases.
KF.2.The presence of ectopic fat and/or visceral adipose tissue is critical to the pathogenesis of MetS and may explain some of the variability in phenotypic presentation across racial groups.
KF.3.A new care model for patients with MetS is essential and should include screening, risk stratification, and algorithmic management of patients according to the specific subtype and stage.
KF.4.Structured lifestyle interventions are required to adequately treat MetS and reduce residual ASCVD risk.
KF.5.Implementation of a new patient care model should focus on integrated care delivery, alternative reimbursement strategies (perhaps utilizing the emerging constructs of the PCMH and ACO), and education that uses structured lifestyle intervention; optimal use of pharmaceuticals, including combination therapies; and appropriate consideration of surgery.