Cardiometabolic risk assessment: an approach to the prevention of cardiovascular disease and diabetes mellitus.

An alarming increase in the development of cardiovascular disease (CVD) during the past 5 decades has led to intensive research on the epidemiology and pathogenesis of CVD, resulting in dramatic improvements in treatment. Today, there is an alarming increase in obesity and diabetes mellitus (DM), with a concomitant increase in diabetes-related complications, including CVD. Researchers have found that the risk of CVD becomes greater with increasing hyperglycemia and insulin resistance that occur in people long before the onset of clinical DM. Lifestyle modification with moderate weight loss has been shown to prevent or delay the onset of DM in patients who are at high risk for developing this disease. Unfortunately, the current guidelines for risk assessment provided by medical societies and national organizations are numerous, confusing, and inconsistent in their basic approach to identify specific risk factors for CVD and DM in patients. Extending routine systematic assessment from cardiovascular risk to cardiometabolic risk--that is, risk for developing CVD and/or DM--and increasing our understanding of the basic mechanisms that regulate energy balance and metabolic risk factors are needed to address this impending epidemic of DM.