Clinical staging to guide management of metabolic disorders and their sequelae: a European Atherosclerosis Society consensus statement

被引：1

作者：

Romeo, Stefano ^{[1
,2
,3
,4
,5
]}

Vidal-Puig, Antonio ^{[6
,7
,8
]}

Husain, Mansoor ^{[9
]}

Ahima, Rexford ^{[10
]}

Arca, Marcello ^{[11
,12
]}

Bhatt, Deepak L. ^{[13
]}

Diehl, Anna Mae ^{[14
]}

Fontana, Luigi ^{[15
,16
]}

Foo, Roger ^{[17
,18
]}

Fruhbeck, Gema ^{[19
,20
,21
,22
]}

Kozlitina, Julia ^{[23
,24
,25
]}

Lonn, Eva ^{[26
,27
]}

Pattou, Francois ^{[28
]}

Plat, Jogchum ^{[29
]}

Quaggin, Susan E. ^{[30
,31
]}

Ridker, Paul M. ^{[32
]}

Ryden, Mikael ^{[33
]}

Segata, Nicola ^{[34
,35
]}

Tuttle, Katherine R. ^{[36
,37
]}

Verma, Subodh ^{[38
]}

van Lennep, Jeanine Roeters ^{[39
]}

Benn, Marianne ^{[40
,41
]}

Binder, Christoph J. ^{[42
]}

Jamialahmadi, Oveis ^{[3
]}

Perkins, Rosie ^{[3
]}

Catapano, Alberico L. ^{[43
,44
]}

Tokgozoglu, Lale ^{[45
]}

Ray, Kausik K. ^{[46
]}

机构：

[1] Karolinska Inst, Dept Med, Endokrinol & Diabet Romeo H7, Medicin H7, S-17177 Stockholm, Sweden

[2] Karolinska Univ Hosp Huddinge, Dept Endocrinol, S-14157 Huddinge, Stockholm, Sweden

[3] Univ Gothenburg, Sahlgrenska Univ Hosp, Inst Med, Sahlgrenska Acad,Dept Mol & Clin Med,Wallenberg La, S-41345 Gothenburg, Sweden

[4] Sahlgrens Univ Hosp, Dept Cardiol, S-41345 Gothenburg, Sweden

[5] Magna Graecia Univ Catanzaro, Dept Med & Surg Sci, Clin Nutr Unit, Viale Europa, I-88100 Catanzaro, Italy

[6] Univ Cambridge, Addenbrookes Hosp, Inst Metab Sci, MRC Metab Dis Unit, Cambridge CB2 0QQ, England

[7] Ctr Invest Principe Felipe, C dEduardo Primo Yufera 3, Valencia 46012, Spain

[8] Univ Cambridge, Nanjing Ctr Technol & Innovat, 23 Rongyue Rd, Nanjing, Jiangsu, Peoples R China

[9] Univ Toronto, Ted Rogers Ctr Heart Res, Dept Med, 661 Univ Ave, Toronto, ON, Canada

[10] Johns Hopkins Univ, Sch Med, Div Endocrinol Diabet & Metab, Dept Med, Baltimore, MD USA

[11] Sapienza Univ Rome, Dept Translat & Precis Med, Rome, Italy

[12] Hosp Policlin Umberto I, Unit Internal Med & Metab Dis, Rome, Italy

[13] Mt Sinai Fuster Heart Hosp, Icahn Sch Med Mt Sinai, New York, NY USA

[14] Duke Univ, Dept Med, Div Gastroenterol, Durham, NC USA

[15] Univ Sydney, Fac Med & Hlth, Charles Perkins Ctr, Camperdown, NSW, Australia

[16] Royal Prince Alfred Hosp, Dept Endocrinol, Camperdown, NSW, Australia

[17] Natl Univ Hlth Syst, Natl Univ Singapore, Cardiovasc Res Inst, Yong Loo Lin Sch Med, Singapore, Singapore

[18] Natl Univ Hlth Syst, Cardiovasc Metab Dis Translat Res Programme, Singapore, Singapore

[19] Univ Navarra, Clin Univ Navarra, Dept Endocrinol & Nutr, Pamplona, Spain

[20] ISCIII, Metab Res Lab, CIBER Fisiopatol Obes & Nutr CIBEROBN, Pamplona, Spain

[21] Inst Invest Sanitaria Navarra IdiSNA, Obes & Adipobiol Grp, Pamplona, Spain

[22] Clin Univ Navarra, Metab Res Lab, Pamplona, Spain

[23] Univ Texas Southwestern Med Ctr, Eugene McDermott Ctr Human Growth & Dev, Dallas, TX USA

[24] Univ Texas Southwestern Med Ctr, Dept Internal Med, Dallas, TX USA

[25] Univ Texas Southwestern Med Ctr, Peter O Donnell Jr Sch Publ Hlth, Dallas, TX USA

[26] McMaster Univ, Dept Med, Hamilton, ON, Canada

[27] McMaster Univ, Populat Hlth Res Inst, Hamilton, ON, Canada

[28] Univ Lille, Inst Pasteur Lille, Dept Endocrine & Metab Surg, CHU Lille, Lille, France

[29] Maastricht Univ, NUTRIM Sch Translat Res Metab, Dept Nutr & Movement Sci, Maastricht, Netherlands

[30] Northwestern Univ, Feinberg Sch Med, Dept Med, Chicago, IL USA

[31] Northwestern Univ, Feinberg Sch Med, Div Nephrol, Chicago, IL USA

[32] Harvard Med Sch, Brigham & Womens Hosp, Ctr Cardiovasc Dis Prevent, Dept Med, Boston, MA USA

[33] Karolinska Univ Hosp Huddinge, Karolinska Inst, Dept Med H7, Stockholm, Sweden

[34] Univ Trento, Dept CIBIO, Trento, Italy

[35] European Inst Oncol IRCCS, Dept Expt Oncol, IEO, Milan, Italy

[36] Univ Washington, Dept Med, Div Nephrol, Seattle, WA USA

[37] Providence Inland Northwest Hlth, Providence Med Res Ctr, Spokane, WA USA

[38] Univ Toronto, Unity Hlth Toronto, Div Cardiac Surg, Li Ka Shing Knowledge Inst,St Michaels Hosp, Toronto, ON, Canada

[39] Erasmus MC, Cardiovasc Inst, Dept Internal Med, Rotterdam, Netherlands

[40] Copenhagen Univ Hosp, Ctr Diagnost Invest, Dept Clin Biochem, Rigshosp, Copenhagen, Denmark

[41] Univ Copenhagen, Fac Hlth & Med Sci, Dept Clin Med, Copenhagen, Denmark

[42] Med Univ Vienna, Dept Lab Med, Vienna, Austria

[43] IRCCS Multimed Sesto S Giovanni, Ctr Study Atherosclerosis, Milan, Italy

[44] Univ Milan, Dept Pharmacol & Biomol Sci, Milan, Italy

[45] Hacettepe Univ, Fac Med, Dept Cardiol, Ankara, Turkiye

[46] Imperial Coll, Dept Primary Care & Publ Hlth, Imperial Ctr Cardiovasc Dis Prevent, London, England

来源：

EUROPEAN HEART JOURNAL | 2025年

关键词：

Obesity; Insulin resistance/pre-diabetes; Type; 2; diabetes; MASLD; Heart failure; Kidney disease; CORONARY-HEART-DISEASE; INTENSIVE MEDICAL THERAPY; FATTY LIVER-DISEASE; C-REACTIVE PROTEIN; TRIGLYCERIDE-RICH LIPOPROTEINS; PRESERVED EJECTION FRACTION; BODY-MASS INDEX; INSULIN-RESISTANCE; CARDIOVASCULAR-DISEASE; ADIPOSE-TISSUE;

D O I：

10.1093/eurheartj/ehaf314

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Obesity rates have surged since 1990 worldwide. This rise is paralleled by increases in pathological processes affecting organs such as the heart, liver, and kidneys, here termed systemic metabolic disorders (SMDs). For clinical management of SMD, the European Atherosclerosis Society proposes a pathophysiology-based system comprising three stages: Stage 1, where metabolic abnormalities such as dysfunctional adiposity and dyslipidaemia occur without detectable organ damage; Stage 2, which involves early organ damage manifested as Type 2 diabetes, asymptomatic diastolic dysfunction, metabolic-associated steatohepatitis (MASH), and chronic kidney disease (CKD); and Stage 3, characterized by more advanced organ damage affecting multiple organs. Various forms of high-risk obesity, driven by maintained positive energy balance, are the most common cause of SMD, leading to ectopic lipid accumulation and insulin resistance. This progression affects various organs, promoting comorbidities such as hypertension and atherogenic dyslipidaemia. Genetic factors influence SMD susceptibility, and ethnic disparities in SMD are attributable to genetic and socioeconomic factors. Key SMD features include insulin resistance, inflammation, pre-diabetes, Type 2 diabetes, MASH, hypertension, CKD, atherogenic dyslipidaemia, and heart failure. Management strategies involve lifestyle changes, pharmacotherapy, and metabolic surgery in severe cases, with emerging treatments focusing on genetic approaches. The staging system provides a structured approach to understanding and addressing the multi-faceted nature of SMD, which is crucial for improving health outcomes. Categorization of SMD abnormalities by presence and progression is aimed to improve awareness of a multi-system trait and encourage a tailored and global approach to treatment, ultimately aiming to reduce the burden of obesity-related comorbidities.

引用

页数：29

共 336 条

[51] Effect of low glycaemic index or load dietary patterns on glycaemic control and cardiometabolic risk factors in diabetes: systematic review and meta-analysis of randomised controlled trials [J].

Chiavaroli, Laura ;

Lee, Danielle ;

Ahmed, Amna ;

Cheung, Annette ;

Khan, Tauseef A. ;

Mejia, Sonia Blanco ;

Mirrahimi, Arash ;

Jenkins, David J. A. ;

Livesey, Geoffrey ;

Wolever, Thomas M. S. ;

Rahelic, Dario ;

Kahleova, Hana ;

Salas-Salvado, Jordi ;

Kendall, Cyril W. C. ;

Sievenpiper, John L. .

BMJ-BRITISH MEDICAL JOURNAL, 2021, 374

[52] Portfolio Dietary Pattern and Cardiovascular Disease: A Systematic Review and Meta-analysis of Controlled Trials [J].

Chiavaroli, Laura ;

Nishi, Stephanie K. ;

Khan, Tauseef A. ;

Braunstein, Catherine R. ;

Glenn, Andrea J. ;

Mejia, Sonia Blanco ;

Rahelic, Dario ;

Kahleova, Hana ;

Salas-Salvado, Jordi ;

Jenkins, David J. A. ;

Kendall, Cyril W. C. ;

Sievenpiper, John L. .

PROGRESS IN CARDIOVASCULAR DISEASES, 2018, 61 (01) :43-53

[53] Effects of Age, Sex, and Obesity on N-Terminal Pro B-Type Natriuretic Peptide Concentrations in the General Population [J].

Choi, Hyo-In ;

Lee, Mi Yeon ;

Oh, Byeong Kil ;

Lee, Seung Jae ;

Kang, Jeong Gyu ;

Lee, Sung Ho ;

Lee, Jong-Young ;

Kim, Byung Jin ;

Kim, Bum Soo ;

Kang, Jin Ho ;

Sung, Ki-Chul .

CIRCULATION JOURNAL, 2021, 85 (05) :647-+

[54] Effect of Gastric Bypass vs Best Medical Treatment on Early-Stage Chronic Kidney Disease in Patients With Type 2 Diabetes and Obesity A Randomized Clinical Trial [J].

Cohen, Ricardo Vitor ;

Pereira, Tiago Veiga ;

Aboud, Cristina Mamedio ;

Zanata Petry, Tarissa Beatrice ;

Lopes Correa, Jose Luis ;

Schiavon, Carlos Aurelio ;

Pompilio, Carlos Eduardo ;

Quirino Pechy, Fernando Nogueira ;

Calmon da Costa Silva, Ana Carolina ;

Gomes de Melo, Fernanda Lendimuth ;

Cunha da Silveira, Livia Porto ;

de Paris Caravatto, Pedro Paulo ;

Halpern, Helio ;

Jacy Monteiro, Frederico de Lima ;

Martins, Bruno da Costa ;

Kuga, Rogerio ;

Sarian Palumbo, Thais Mantovani ;

Docherty, Neil Gerard ;

le Roux, Carel Wynand .

JAMA SURGERY, 2020, 155 (08)

[55]

Colberg SR, 2010, DIABETES CARE, V33, P2692, DOI 10.2337/dc10-9990

[56] Long-term kidney outcomes of semaglutide in obesity and cardiovascular disease in the SELECT trial [J].

Colhoun, Helen M. ;

Lingvay, Ildiko ;

Brown, Paul M. ;

Deanfield, John ;

Brown-Frandsen, Kirstine ;

Kahn, Steven E. ;

Plutzky, Jorge ;

Node, Koichi ;

Parkhomenko, Alexander ;

Ryden, Lars ;

Wilding, John P. H. ;

Mann, Johannes F. E. ;

Tuttle, Katherine R. ;

Idorn, Thomas ;

Rathor, Naveen ;

Lincoff, A. Michael .

NATURE MEDICINE, 2024, 30 (07) :2058-2066

[57] Autoimmune diseases and cardiovascular risk: a population-based study on 19 autoimmune diseases and 12 cardiovascular diseases in 22 million individuals in the UK [J].

Conrad, Nathalie ;

Verbeke, Geert ;

Molenberghs, Geert ;

Goetschalckx, Laura ;

Callender, Thomas ;

Cambridge, Geraldine ;

Mason, Justin C. ;

Rahimi, Kazem ;

McMurray, John J., V ;

Verbakel, Jan Y. .

LANCET, 2022, 400 (10354) :733-743

[58] Estimation of ten-year risk of fatal cardiovascular disease in Europe:: the SCORE project [J].

Conroy, RM ;

Pyörälä, K ;

Fitzgerald, AP ;

Sans, S ;

Menotti, A ;

De Backer, G ;

De Bacquer, D ;

Ducimetière, P ;

Jousilahti, P ;

Keil, U ;

Njolstad, I ;

Oganov, RG ;

Thomsen, T ;

Tunstall-Pedoe, H ;

Tverdal, A ;

Wedel, H ;

Whincup, P ;

Wilhelmsen, L ;

Graham, IM .

EUROPEAN HEART JOURNAL, 2003, 24 (11) :987-1003

[59]

Cosentino F., 2020, EUR HEART J, V41, P255, DOI DOI 10.1093/EURHEARTJ/EHZ486

[60] ApoCIII: A multifaceted protein in cardiometabolic disease [J].

D'Erasmo, Laura ;

Di Costanzo, Alessia ;

Gallo, Antonio ;

Bruckert, Eric ;

Arca, Marcello .

METABOLISM-CLINICAL AND EXPERIMENTAL, 2020, 113

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