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Identification and Management of Cardiometabolic Risk in Canada

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Canadian Cardiometabolic Risk Working Group

Version 1.1.0 GM

Authors
Cardiometabolic Risk Working Group: Executive Committee

Developers
Edward Brawer BSc (Hons)
Chi-Ming Chow MD MSc FRCPC

Copyright © 2011-2012 Canadian Cardiometabolic Risk Working Group. All Rights Reserved.



The development of this application was sponsored by Servier.


The Waist Circumference - Professional Measurement & Self-Measurement videos are used with permission from myhealthywaist.org. Copyright © 2011 International Chair on Cardiometabolic Risk. All Rights Reserved.


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Disclaimer

The guideline summaries and calculators provided are for information purposes only. They are not meant to be a substitute for professional advise and are not to be used for medical diagnosis. All recommendations, tables, figures, and calculations must be confirmed before clinical use or diagnostic purposes by qualified medical professionals. The authors make no claims of the accuracy of the information contained herein. The authors make no claims whatsoever, expressed or implied, about the authenticity, accuracy, reliability, completeness or timeliness of the material, software, text, graphics and links given. In no event shall the authors, its suppliers, affiliates or any third parties be liable in any manner whatsoever for any damage arising upon use of any information provided.

Abstract

Definition

Identification of cardiometabolic risk

Harmonized definitions of metabolic syndrome

Advantages and limitations of the clinical diagnosis of metabolic syndrome*

How to measure waist circumferences

Recommended technique for measuring blood pressure

Thresholds and criteria for screening for dyslipidemia and dysglycemia

Tests and diagnostic criteria and thresholds for treatment

Treatment targets

Summary of nutritional and physical activity considerations

Effects of health behaviour modification on cardiometabolic risk

Use of weight-loss medications

Who should be considered for bariatric surgery?

Special populations

     English
Introduction to CMR
Waist Circumference Measurement - Healthcare Professional
Waist Circumference Measurement - Self
     Français
Introduction au RCM
Mesure de la circonférence du tour de taille pour les professionnels des soins de santé
Auto-mesure de la circonférence du tour de taille


Cardiometabolic Risk Working Group: Executive Committee, et al. Identification and management of cardiometabolic risk in Canada: a position paper by the cardiometabolic risk working group (executive summary). Can J Cardiol. 2011 Mar-Apr; 27(2):124-31.
Cardiometabolic Risk Working Group: Executive Committee, et al. Cardiometabolic risk in Canada: a detailed analysis and position paper by the cardiometabolic risk working group. Can J Cardiol. 2011 Mar-Apr; 27(2):e1-e33.


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CVD Risk

BMI


Weight   
Height   
BMI   kg/m2
Classification

WHO BMI Classification

BMI Target*Asian BMI Target*Risk
 
Underweight
<18.5<18.5Low
 
Ideal Range
18.5-24.918.5-22.9Average
 
Overweight
25-29.923-24.9Increased
 
Obese (Class I)
30-34.925-29.9Moderate
 
Obese (Class II)
35 or more30 or moreSevere
 
*kg/m2
BMI values may not be correct for all ethnic populations.

WC Target
 
Europids
Male≥94 cm
Female≥80 cm
 
Non-Europids
Male≥90 cm
Female≥80 cm
 
Tx
Units: 
Age   years
Gender
Total Cholesterol   mmol/L
HDL Cholesterol   mmol/L
Systolic BP   mmHg
BP is treated
Diabetes
Smoker
     Metabolic Syndrome
Ethnicity
Waist Circumference
≥94 cm (37.0 in)
Plasma Triglycerides
≥1.7 mmol/L or tx
HDL Cholesterol
<1.0 mmol/L or tx
BP ≥130/85 mmHg or
tx for hypertension
Fasting Plasma Glucose
≥5.6 mmol/L or tx
10-year CVD risk -
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General Assessment of CMR
Assessment and Quantification
Approach for Increased Risk
Pharmacological Interventions
Integrated Management

High risk for CVD (≥20%):

Consider treatment in all patients. Indication for lipid lowering medication, primarily statins.

Primary target: LDL-C <2.0 mmol/L (or ≥50% reduction in LDL-C); Alternate primary target: Apo B <0.80 g/L

Moderate risk for CVD (10-19%):

Treat if:

Primary target: LDL-C <2.0 mmol/L (or ≥50% reduction in LDL-C); Alternate primary target: Apo B <0.80 g/L

Low risk for CVD (<10%):

Treat if LDL-C ≥5.0 mmol/L

Primary target: ≥50% reduction in LDL-C; Alternate primary target: NA

Abbreviations

CVD, cardiovascular disease;HDL-C, high-density lipoprotein cholesterol; hs-CRP, high-sensitivity C-reactive protein; LDL-C, low-density lipoprotein cholesterol; TC, total cholesterol.