The term cardiometabolic risk describes a person’s chances of damaging their heart and blood vessels when one or more risk factors are present.
What is cardiometabolic risk?
The term cardiometabolic risk describes a person’s chances of having a cardiovascular event such as heart attack or stroke when one or more risk factors are present. Some major risk factors include:
- High LDL (“bad”) cholesterol
- High blood fat (triglycerides)
- Low HDL (“good”) cholesterol
- High blood pressure
- Smoking tobacco
Each of these risk factors is dangerous on its own, but a combination greatly increases the risk of heart disease and stroke.
Who is at risk?
People with the risk factors above can have a higher risk of cardiovascular disease. The severity of these risk factors and the number of them impact how high that risk is. Other conditions that can potentially increase the risk for heart disease include kidney disease, inflammatory diseases (ex. rheumatoid arthritis), family history of early heart disease or stroke, and early menopause. Certain ethnic groups may also have a higher risk for heart disease.
It is important to discuss risk factors with your doctor so they can help give you an estimate of your risk for developing a heart attack or stroke, and so that they can work with you to minimize that risk.
Cardiometabolic Risks Factors
|Danger Zones||Where You Want to Be|
|Obesity: BMI 25-29.9 is considered overweight and a BMI >30 is considered obese.||A body mass index (BMI) of 18.5 to 24.9 for normal weight. (BMI is calculated from your height and weight.)|
|LDL greater than 100 mg/dl.||Less than 70 mg/dl.|
|HDL less than 40 mg/dl in men and less than 50 mg/dl in women.||Greater than 40 mg/dl in men and 50 mg/dl in women.|
|Triglycerides greater than 150 mg/dl||Triglycerides less than 150 mg/dl|
|Blood pressure greater than 130/80||Recommended: Systolic less Blood pressure less than 130/80|
|Fasting blood glucose greater than 100 mg/dl or already diagnosed type 2 diabetes||Blood glucose after an 8-hour fast less than 100 mg/dl|
How is cardiometabolic risk treated?
In order to reduce cardiovascular risk, it is important to improve any risk factors that can be modified. For instance, if an individual has diabetes, maintaining good control of the diabetes is important for minimizing risk. Changes in diet, exercise, and lifestyle are the first steps toward weight loss for people who are overweight or obese. Your doctor will work with you to determine the best management options for you depending upon your risk factors and degree of cardiometabolic risk.
How can you lower your risk of cardiovascular problems?
One of the best things you can do to lower your risk of cardiovascular disease is to adopt a healthy lifestyle. For example, exercising regularly, eating a healthy diet, smoking cessation, and avoiding excess alcohol are all important for maintaining a healthy lifestyle.
If you think you may have one or more of the risk factors described above, talk with your doctor to determine your cardiometabolic risk and decide on the best options for management.
Questions to ask your healthcare team:
- Am I at risk for cardiometabolic problems?
- Which risk factors do I have?
- What can I do to lower my risk?
- What are my options for treatment, including lifestyle changes and medications?
- What are the risks and benefits of each of my options?
Cardiovascular disease and type 2 diabetes is preventable, but your risk can increase greatly if there is a metabolic risk for developing these conditions. Learn more about the management and lifestyle recommendations to prevents these conditions.
What causes cardiovascular disease and Type 2 Diabetes?
Cardiovascular disease and type 2 diabetes are chronic metabolic conditions that are caused by a combination of genetic risk, environmental and lifestyle factors. Risks associated with lifestyle include tobacco use, intake of high calorie, poor nutrient foods, and sedentary behavior with low levels of physical activity. Other risk factors for type 2 diabetes are not modifiable, such as age, ethnic origin, family history of diabetes, and some genetic markers.
How are cardiovascular disease and type 2 diabetes diagnosed?
Type 2 diabetes is diagnosed by measuring the levels of sugar (glucose) in your blood, or some blood markers (hemoglobin A1c) reflecting the levels of glucose in circulation.
Cardiovascular disease can be diagnosed based on symptoms such as chest pain called angina, leg pain while walking, and weakness or neurological symptoms typical of stroke. These symptoms are caused by the narrowing or blockage of vessels in your heart, in your brain, or elsewhere in your body. Your doctor can also detect or screen for the presence of narrowing of vessels by imaging tests.
What are the signs & symptoms suggestive of Type 2 diabetes and cardiovascular disease?
You can reduce your risk of getting heart disease and diabetes with 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
When blood sugars get very high, people can have excessive thirst, increase urination, and weight loss. High blood sugars can also lead to a narrowing or blockage of vessels in your heart can lead to chest pain called angina, or myocardial infarction that people often called ‘heart attack’. Blockage of vessels in your brain is called a stroke and can lead to weakness or tingling in parts of your body, difficulty speaking, and many other neurological symptoms. Narrowing of vessels in your legs can lead to leg pain when you walk, and if severe it may even require amputation.
Terms you should know
High Metabolic Risk: a cluster of diseases that develop as a result of poor lifestyle behaviors, genetic factors
Cardiovascular Disease: also known as heart disease, a disease that narrows or blocks the valves in the heart.
Prediabetes: occurs when blood glucose levels are higher than normal, but not high enough for a diabetes diagnosis.
Metabolic Syndrome: clustered risk factors, which include obesity, high blood pressure, elevated triglycerides, low high-density lipoprotein-cholesterol (HDL) “good” cholesterol, and abnormal elevation of blood sugar.
Hypertension: also known as high blood pressure this condition often has no symptoms and is the leading cause of cardiovascular disease.
High-Density Lipoprotein (HDL): also known as “good cholesterol” because it helps to remove other cholesterol from the bloodstream.
Low-Density Lipoprotein (LDL): also known as “bad cholesterol” makes up most of your body’s cholesterol and can increase your risk for heart disease and stroke.
About one-third of all US adults are considered at high metabolic risk.
Common metabolic and diabetes risk factors include:
- elevations of triglycerides (TGLs)
- reduced levels of high-density lipoprotein-cholesterol (HDL)
- increased plasma glucose levels
- systemic hypertension (high blood pressure)
- enlarged waist circumference due to large amount of abdominal body fat
- a prothrombotic state (increased risk of blood clots in the blood vessels)
- a proinflammatory state (increased risk of inflammation)
People who have been identified as having prediabetes should be tested annually for type 2 diabetes. For someone with high metabolic risk, especially with prediabetes, the best way to lower the risk of progressing towards type 2 diabetes is to adopt lifestyle changes. Risk factors that increase your risk of developing type 2 diabetes include excess weight (especially around the waist), food intake rich in calories and simple sugars, low level of physical activity, high amount of sedentary time (sitting or lying down), tobacco use, and some medications. Other markers can also indicate a higher risk of developing diabetes such as different types of blood cholesterol levels (high triglycerides and low HDL) and high blood pressure.
Management & Prevention
For individuals at high metabolic risk, the first line of therapy is lifestyle changes. Most successful lifestyle interventions are comprehensive programs led by trained health professionals which support the adoption of healthy lifestyles, including diet and physical activity, aiming for moderate but sustained weight loss. For individuals at metabolic risk with excess weight, comprehensive programs to support the adoption of a healthy lifestyle should aim to achieve a weight loss of at least 5% of initial body weight. All individuals at high metabolic risk should adopt a cardiovascular-healthy diet that includes a high amount of vegetables, fruits, whole grains, nuts, legumes, unsaturated oils, low-fat dairy, poultry, and fish; and low amount of sodium, red and processed meat, high-fat dairy, and sugar-sweetened foods and drinks. Caloric reduction is often part of weight loss programs.
All individuals at high metabolic risk should aim to limit their amount of sedentary time and to be physically active on a daily basis. Walking is a great way to be active and is safe for most people. Structured activity programs may be appropriate for some individuals. Lifestyle interventions should also address factors such as tobacco cessation, stress management, and sleep hygiene. In individuals with prediabetes, if lifestyle intervention is not possible or not successful, some medications may be needed to slow down the progression towards type 2 diabetes. For individuals at high metabolic risk, the blood pressure goal should be less than 130/80 mm Hg. Lifestyle approaches including sodium reduction, cardiovascular healthy diet, regular physical activity, and weight loss lead to significant improvement in blood pressure. Blood pressure medications should be added if lifestyle changes are not successful or insufficient to reach pressure less than 130/80 mm Hg.
Depending on your risk of developing cardiovascular disease and your level of “bad cholesterol” some medications such as statins may be needed to prevent “heart attack” or stroke. Type 2 Diabetes is preventable! The longer you have diabetes, the higher the chances of developing heart disease. Over time, high blood glucose can damage your blood vessels that control your heart. Lifestyle behaviors including cardiovascular-healthy diet, daily physical activity, and avoiding tobacco is the best way to prevent type 2 diabetes and cardiovascular diseases.
Questions to ask your healthcare team
Both type 2 diabetes and cardiovascular diseases can progress over many years without symptoms, which is why it’s important to talk about it with your doctor about what screenings or tests are appropriate for you.
- Should I have my blood glucose, and cholesterol levels checked?
- Should my waist circumference be measured?
- Is my blood pressure at a healthy level?
- What are the programs available to help me adopt a healthy lifestyle?
- Should I see an endocrinologist or diabetes educator?
Lipids are essential to our health and wellbeing. Lipids also play a role in protection, lubrication, insulation, and are the building blocks for certain hormones. Learn what happens if your lipids are too high or too low.
What are Lipids?
The term lipids refer to any group of fats in the blood, including triglycerides and cholesterol. Triglycerides are an important source of energy, and cholesterol is used to make vitamin D and some hormones. Cholesterol is a waxy, fat-like substance that is found in all cells in the body. Cholesterol is also found in foods from animal sources. The body requires only a small amount of lipids to function. If triglyceride levels are too high, the risk for pancreatitis (inflammation of the pancreas) is increased. When cholesterol levels are too high, fat is deposited in the artery walls, and this can lead to heart disease and stroke.
How are Abnormal Lipid Levels Diagnosed?
Abnormal lipid levels are diagnosed by a blood test called a lipid panel. The lipid panel measures LDL (low-density lipoprotein) and HDL (high-density lipoprotein) cholesterol, as well as triglycerides. LDL is also known as bad cholesterol. High levels of LDL cholesterol increase the risk for heart disease and stroke. HDL is known as good cholesterol. It picks up excess cholesterol in the bloodstream and is associated with a lower risk of heart disease and stroke. In most cases, lipid testing can be done without any changes in your daily routine. Your doctor may request you to fast for 12 hours prior to testing to avoid significant changes in lipid levels that can be affected by foods eaten. This is known as a fasting lipid profile. A non-fasting lipid profile allows patients to eat before drawing blood. This may be a preferred method for patients with diabetes who experience hypoglycemia after fasting. If lipid levels are high, your clinician will ask about your family history and lifestyle. Sometimes, high lipid levels or a lipid disorder may require diagnosis by a health care provider who is a specialist. Additional testing may be done to eliminate other causes of high lipids, such as thyroid disease or another endocrine condition.
Lipid levels can change and become abnormal due to the following:
- Certain drugs
- Endocrine diseases such as diabetes, hypothyroidism, hyperthyroidism, Cushing syndrome, chronic use of steroids, acromegaly, and polycystic ovary syndrome (PCOS)
Lipid Pathways and Hormones
Hormones control every pathway for fats and proteins and are transported to support metabolism. The primary hormones involved in this process are estrogen, testosterone, insulin, cortisol, thyroid hormone, growth hormone, and glucagon.
Signs and Symptoms
It is important to note that high cholesterol and triglycerides often have no symptoms. They can only be detected by a lipid panel. If left untreated, high cholesterol can lead to chest pain, heart attack or stroke, and high triglycerides can lead to pancreatitis.
Advice for Screening and Treatment
For adults with endocrine disorders, experts recommend a lipid panel to measure triglyceride levels and to calculate LDL cholesterol. A lipid panel helps determine the risk for heart disease and stroke and helps guide decisions for treatment if the risk of heart disease and stroke is borderline, intermediate, or high. Experts recommend conducting cardiovascular risk assessment by reviewing traditional risk factors, including calculation of 10-year risk for atherosclerotic cardiovascular disease. For patients with type 2 diabetes, doctors recommend statin therapy to reduce the risk for heart disease, and 10-year risk assessment may not be needed.
- For patients with hypertriglyceridemia (high triglycerides) with levels over 500 mg/dL, experts recommend medication, in addition to diet and exercise to prevent pancreatitis.
- For patients with obesity, experts recommend making lifestyle changes to lower triglyceride levels, which will decrease the risk for pancreatitis. Some patients may also need medications to reduce weight, or undergo weight loss surgery.
- For patients that undergo weight loss surgery, experts recommend scheduling an appointment with a doctor to measure the lipid panel after recovery from surgery to assess the risk for heart disease.
- For patients with type 2 diabetes and diabetic retinopathy, experts suggest using medications called fibrates in addition to statins to reduce the progression of retinopathy.
- In patients with hypothyroidism or hyperthyroidism, the lipid panel should be assessed after the patient’s thyroid levels are normal again, in order to determine the need for lipid-lowering medication.
- For patients with Cushing Syndrome (excess cortisol levels), experts recommend therapies to lower lipid levels to reduce heart disease.
- Experts recommend a fasting screening lipid panel at diagnosis to assess cardiovascular risk in women with PCOS. Lifestyle choices can help lower lipid levels in these women. Lipid-lowering medication is not advised in women with PCOS to treat elevated testosterone levels or infertility.
- In women who have undergone menopause, experts recommend treating lipid abnormalities with statin therapy rather than hormone therapy because hormone therapy can increase the risk for cardiovascular disease.
- For men with low testosterone levels, testosterone therapy should not be used to treat abnormal lipid levels or heart disease risk.
- For transgender patients who have taken or are taking gender-affirming hormone therapy, traditional guidelines for assessing cardiovascular risk should be followed.
What Treatment Options Are Available?
Common treatment options to lower lipids may include diet and exercise, and medications such as statins. Options to reduce the risk of heart disease include quitting smoking and using diet and medications to reduce LDL cholesterol, blood pressure, and glucose levels. Other recommended lifestyle changes may include weight loss, and increasing physical activity.
Endocrinologists are the medical detectives who can help uncover lipid abnormalities.