The European Atherosclerosis Society proposes a three-stage clinical system based on pathophysiology to guide the management of systemic metabolic disorders and their sequelae.
A new clinical staging system for systemic metabolic disorders provides a structured approach to understanding and managing the sequelae of excess adiposity.
This Focus Issue on ischaemic heart disease, diabetes, and metabolic disorders contains a Special Article entitled 'Clinical staging to guide management of metabolic disorders and their sequelae: a European Atherosclerosis Society consensus statement' by Stefano Romeo from the Karolinska Institute in Stockholm, Sweden, and colleagues which presents a clinically intuitive staging system based on diverse data related to the cluster of abnormalities associated with excess adiposity. 1Obesity remains a challenging risk factor. 2-9Indeed, obesity rates have surged worldwide since 1990.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 SMDs, 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 (T2D), 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 SMDs, 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 SMDs are attributable to genetic and socioeconomic factors.Key SMD features include insulin resistance, inflammation, pre-diabetes, T2D, 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 multifaceted nature of SMDs, which is crucial for improving health outcomes.Categorization of SMD
Filippo Crea (Tue,) conducted a editorial in Systemic metabolic disorders, obesity, and diabetes. Clinical staging system was evaluated. The European Atherosclerosis Society proposes a three-stage clinical system based on pathophysiology to guide the management of systemic metabolic disorders and their sequelae.
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