Metabolic Profiles—Based on the 2013 Prevention Guidelines

  • Neil J. StoneEmail author
  • John Wilkins
  • Sakina Kazmi


This chapter reviews the utility of measuring biometric parameters as they relate to the practice of lifestyle medicine and estimating risk for type-2 diabetes (T2D) and atherosclerotic cardiovascular disease (ASCVD). The new 2013 American College of Cardiology-American Heart Association (ACC-AHA) Prevention Guidelines provide guidance as to which additional factors aid in improved net reclassification. These are explored in detail. The 2013 ACC-AHA Guidelines recommended lifestyle change as the foundation for primary prevention and also as crucially important to deal with residual risk in secondary prevention. The assessment of the metabolic syndrome (MetS)continues to be of clinical value to clinicians as it identifies metabolic parameters that are easily measurable, understood by the patient as markers of a poor cardio-metabolic prognosis, and importantly, markers that all improve with lifestyle changes.


Metabolic syndrome Atherosclerotic cardiovascular risk Biomarkers Coronary artery calcium score Residual risk 



Ankle Brachial Index


American College of Cardiology-American Heart Association


Atherosclerotic cardiovascular disease


Coronary artery calcium


Confidence interval


Carotid intima-media thickness


Coronary heart disease


Chronic kidney disease


Cardiovascular disease


Diabetes Prevention Program


Glomerular filtration rate


High-density lipoprotein cholesterol


Intermediate-density lipoprotein


Low-density lipoprotein cholesterol


Metabolic syndrome


Multi-Ethnic Study of Atherosclerosis


National Health and Nutrition Examination Surveys


Nuclear magnetic resonance


Peripheral artery disease


Relative risk


Type-2 diabetes




The Obesity Society


Very low-density lipoprotein


  1. 1.
    Eckel RH, Jakicic JM, Ard JD, de Jesus JM, Houston Miller N, Hubbard VS, Lee IM, Lichtenstein AH, Loria CM, Millen BE, Nonas CA, Sacks FM, Smith SC Jr, Svetkey LP, Wadden TA, Yanovski SZ. 2013 AHA/ACC Guideline on lifestyle management to reduce cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;63(25 Pt B):2960–84.CrossRefPubMedGoogle Scholar
  2. 2.
    Jensen MD, Ryan DH, Apovian CM, Ard JD, Comuzzie AG, Donato KA, Hu FB, Hubbard VS, Jakicic JM, Kushner RF, Loria CM, Millen BE, Nonas CA, Pi-Sunyer FX, Stevens J, Stevens VJ, Wadden TA, Wolfe BM, Yanovski SZ. 2013 AHA/ACC/TOS Guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. J Am Coll Cardiol. 2014;63(25 Pt B):2985–3023.CrossRefPubMedGoogle Scholar
  3. 3.
    Goff DC Jr, Lloyd-Jones DM, Bennett G, Coady S, D’Agostino RB Sr, Gibbons R, Greenland P, Lackland DT, Levy D, O’Donnell CJ, Robinson JG, Schwartz JS, Shero ST, Smith SC Jr, Sorlie P, Stone NJ, Wilson PW. 2013 ACC/AHA Guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;63(25 Pt B):2935–59.CrossRefPubMedGoogle Scholar
  4. 4.
    Stone NJ, Robinson JG, Lichtenstein AH, Bairey Merz CN, Blum CB, Eckel RH, Goldberg AC, Gordon D, Levy D, Lloyd-Jones DM, McBride P, Schwartz JS, Shero ST, Smith SC Jr, Watson K, Wilson PW. 2013 ACC/AHA Guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;63(25 Pt B):2889–934.Google Scholar
  5. 5.
    Grundy S. Approach to lipoprotein management in 2001 National Cholesterol Guidelines. Am J Cardiology. 2002;90(8A), 11i–21i.CrossRefGoogle Scholar
  6. 6.
    Ferland A, Eckel RH. Does sustained weight loss reverse the metabolic syndrome? Curr Hypertens Rep. 2011;13(6):456–64.CrossRefPubMedGoogle Scholar
  7. 7.
    Motillo S, Filion KB, Genest J, Joseph L, Pilote L, Poirier P, Rinfret S, Schiffrin EL, Eisenberg MJ. The metabolic syndrome and cardiovascular risk: a systematic review and meta-analysis. J Am Coll Cardiol. 2010;56:1113–32.CrossRefGoogle Scholar
  8. 8.
    Greenland P et al. ACCF/AHA Guideline for assessment of cardiovascular risk in asymptomatic adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2010;56(25):e50–103.CrossRefPubMedGoogle Scholar
  9. 9.
    Lloyd-Jones DM, Nam B, D’Agotino RB, Murabito JM, Wang TJ, Wilson PWF, O’Donnell CJ. Parental cardiovascular disease as a risk factor for cardiovascular disease in middle-aged adults—a prospective study of parents and offspring. JAMA. 2004;291(18):2204–11.CrossRefPubMedGoogle Scholar
  10. 10.
    Williams RR, Hunt SC, Heiss G. Usefulnes of cardiovascular family history data for population-based preventive medicine and medical research (the Healthy Family Tree Study and the NHLBI Family Heart Study). Am J Cardiol. 2001;87:129–35.CrossRefPubMedGoogle Scholar
  11. 11.
    Hawe E, Talmud PJ, Miller GJ, Humphries SE. Family history is a coronary heart disease risk factor in the Second Northwick Park Heart Study. Ann Hum Genet. 2003;87:97–106.CrossRefGoogle Scholar
  12. 12.
    Okwuosa TM, Greenland P, Lakoski SG, Ning H, Kang J, Blumenthal RS, Szklo M, Crouse JR 3rd, Lima JA, Liu K, Lloyd-Jones DM. Factors associated with presence and extent of coronary calcium in those predicted to be at low risk according to Framingham risk score (from the Multi-ethnic Study of Atherosclerosis). Am J Cardiol. 2011;107:879–85.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Lin JS, Olson CM, Johnson ES, Whitlock EP. The ankle-brachial index for peripheral artery disease screening and cardiovascular disease prediction among asymptomatic adults: a systematic evidence review for the U.S. Preventive Services Task Force. Ann Intern Med. 2013;159:333–41.CrossRefPubMedGoogle Scholar
  14. 14.
    Elliott P, Chambers JC, Zhang W. Genetic loci associated with C-reactive protein levels and risk of coronary heart disease. JAMA. 2009;302:37–48.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Buckley DI, Fu R, Freeman M, Rogers K, Helfand M. C-reactive protein as a risk factor for coronary heart disease: a systematic review and meta-analyses for the U.S. Preventive Services Task Force. Ann Intern Med. 2009;151:483–95.CrossRefPubMedGoogle Scholar
  16. 16.
    Wilson PW, Nam BH, Pencina M, et al. C-reactive protein and risk of cardiovascular disease in men and women from the Framingham Heart Study. Arch Intern Med. 2005;165:2473–8.CrossRefPubMedGoogle Scholar
  17. 17.
    Cook NR, Buring JE, Ridker PM. The effect of including C-reactive protein in cardiovascular risk prediction models for women. Ann Intern Med. 2006;145:21–9.CrossRefPubMedGoogle Scholar
  18. 18.
    Van der Meer IM, de Maat MP, Kiliaan AJ, et al. The value of C-reactive protein in cardiovascular risk prediction: the Rotterdam Study. Arch Intern Med. 2003;163:1323–8.CrossRefPubMedGoogle Scholar
  19. 19.
    Wilson PW, Pencina M, Jacques P, et al. C-reactive protein and reclassification of cardiovascular risk in the Framingham Heart Study. Circ Cardiovasc Qual Outcomes. 2008;1:92–7.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Ridker PM, Danielson E, Fonseca FA. Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein. N Engl J Med. 2008;359:2195–207.CrossRefPubMedGoogle Scholar
  21. 21.
    Hlatky MA, Greenland P, Arnett DK, Ballantyne CM, Criqui MH, Elkind MS, Go AS, Harrell FE Jr, Hong Y, Howard BV, Howard VJ, Hsue PY, Kramer CM, McConnell JP, Normand SL, O’Donnell CJ, Smith SC Jr, Wilson PW, American Heart Association Expert Panel on Subclinical Atherosclerotic Diseases and Emerging Risk Factors and the Stroke Council. Criteria for evaluation of novel markers of cardiovascular risk: a scientific statement from the American Heart Association. Circulation. 2009;119(17):2408–16.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Khan KM, Weiler R, Blair SN. Prescribing exercise in primary care—ten practical steps on how to do it. BMJ. 2011;343:d4141.CrossRefPubMedGoogle Scholar
  23. 23.
    Sniderman A, Couture P, de Graaf J. Diagnosis and treatment of apolipoprotein B dyslipoproteinemias. Nat Rev Endocrinol. 2010;6(6):335–46.CrossRefPubMedGoogle Scholar
  24. 24.
    Ford ES, Li C, Sniderman A. Temporal changes in concentrations of lipids and apolipoprotein B among adults with diagnosed and undiagnosed diabetes, prediabetes, and normoglycemia: findings from the National Health and Nutrition Examination Survey 1988–1991 to 2005–2008. Cardiovasc Diabetol. 2013;30(12):26.CrossRefGoogle Scholar
  25. 25.
    Barter PJ et al. Apo B versus cholesterol in estimating cardiovascular risk and in guiding therapy: report of the thirty-person/ten-country panel. J Intern Med. 2006;259(3):247–58.CrossRefPubMedGoogle Scholar
  26. 26.
    Sniderman AD, Williams K, Contois JH, et al. A meta-analysis of low-density lipoprotein cholesterol, non-high-density lipoprotein cholesterol, and apolipoprotein B as markers of cardiovascular risk. Circ Cardiovasc Qual Outcomes. 2011;4(3):337–45.CrossRefPubMedGoogle Scholar
  27. 27.
    Sniderman AD, De Graaf J, Couture P. Low-density lipoprotein-lowering strategies: target versus maximalist versus population percentile. Curr Opin Cardiol. 2012;27(4):405–11.CrossRefPubMedGoogle Scholar
  28. 28.
    AD1 S, St-Pierre AC, Cantin B, et al. Concordance/discordance between plasma apolipoprotein B levels and the cholesterol indexes of atherosclerotic risk. Am J Cardiol. 2003;91(10):1173–7.Google Scholar
  29. 29.
    Ingelsson E, Schaefer EJ, Contois JH, et al. Clinical utility of different lipid measures for prediction of coronary heart disease in men and women. JAMA. 2007;298(7):776–85.CrossRefPubMedGoogle Scholar
  30. 30.
    Bakris GL, Molitch M. Microalbuminuria as a risk predictor in diabetes: the continuing saga. Diabetes Care. 2014;37(3):867–75.CrossRefPubMedGoogle Scholar
  31. 31.
    Tagle R, Acevedo M, Vidt D. Microalbuminuria: is it a valid predictor of cardiovascular risk? Cleve Clin J Med. 2003;70(3):255–61.CrossRefPubMedGoogle Scholar
  32. 32.
    Zhang Y, Guallar E, Qiao Y, Wasserman BA. Is carotid intima-media thickness as predictive as other noninvasive techniques for the detection of coronary artery disease? Arterioscler Thromb Vasc Biol. 2014;34(7):1341–5.CrossRefPubMedGoogle Scholar
  33. 33.
    Mora S, Szklo M, Otvos JD, et al. LDL particle subclasses, LDL particle size, and carotid atherosclerosis in the Multi-Ethnic Study of Atherosclerosis (MESA). Atherosclerosis. 2007;192:211–7.CrossRefPubMedGoogle Scholar
  34. 34.
    Mora S, Otvos JD, Rosenson RS, Pradhan A, Buring JE, Ridker PM. Lipoprotein particle size and concentration by nuclear magnetic resonance and incident type 2 diabetes in women. Diabetes. 2010;59(5):1153–60 (2010 Feb 25).CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Shalaurova I, Connelly MA, Garvey WT, Otvos JD. Lipoprotein insulin resistance index: a lipoprotein particle-derived measure of insulin resistance. Metab Syndr Relat Disord. 2014;12(8):422–9.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Mora S, Otvos JD, Rifai N, Rosenson RS, Buring JE, Ridker PM. Lipoprotein particle profiles by nuclear magnetic resonance compared with standard lipids and apolipoproteins in predicting incident cardiovascular disease in women. Circulation. 2009;119(7):931–9.CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Otvos JD, Mora S, Shalaurova I, Greenland P, Mackey RH, Goff DC Jr. Clinical implications of discordance between low-density lipoprotein cholesterol and particle number. J Clin Lipidol. 2011;5(2):105–13.CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Kilgore M, Muntner P, Woolley JM, Sharma P, Bittner V, Rosenson RS. Discordance between high non-HDL cholesterol and high LDL-cholesterol among US adults. J Clin Lipidol. 2014;8(1):86–93.CrossRefPubMedGoogle Scholar
  39. 39.
    Tuteja S, Rader DJ. Dyslipidaemia: cardiovascular prevention–end of the road for niacin? Nat Rev Endocrinol. 2014;10:646–47.CrossRefPubMedGoogle Scholar
  40. 40.
    Orchard TJ, Temprosa M, Goldberg R, Haffner S, Ratner R, Marcovina S, Fowler S. The effect of metformin and intensive lifestyle intervention on the metabolic syndrome: the diabetes prevention program randomized trial. Ann Intern Med. 2005;142:611–9.CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Mora S, Wenger NK, DeMicco DA, Breazna A, Boekholdt SM, Arsenault BJ, Deedwania P, Kastelein JJP, Waters DD. Determinants of residual risk in secondary prevention patients treated with high- versus low-dose statin therapy: the Treating to New Targets (TNT) study. 125(16):1979-87.Google Scholar
  42. 42.
    2013 Prevention Guidelines ASCVD Risk Estimator. Accessed 15 March 2015.

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Feinberg School of Medicine, Northwestern UniversityChicagoUSA
  2. 2.Department of Preventive MedicineFeinberg School of Medicine, Northwestern UniversityChicagoUSA
  3. 3.Department of CardiologyFeinberg School of Medicine, Northwestern UniversityChicagoUSA

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