Objective: To develop clinical practice guidelines for the primary prevention of cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM) in patients at metabolic risk.

Conclusions: Health care providers should incorporate into their practice concrete measures to reduce the risk of developing CVD and T2DM. These include the regular screening and identification of patients at metabolic risk (at higher risk for both CVD and T2DM) with measurement of blood pressure, waist circumference, fasting lipid profile, and fasting glucose.

All patients identified as having metabolic risk should undergo 10-year global risk assessment for either CVD or coronary heart disease. This scoring will determine the targets of therapy for reduction of apo B-containing lipoproteins. Careful attention should be given to the treatment of elevated blood pressure to the targets outlined in this guideline. The prothrombotic state associated with metabolic risk should be treated with lifestyle modification measures and in appropriate individuals with low-dose aspirin prophylaxis.

Patients with pre-diabetes (IGT or IFG) should be screened at 1- to 2-year intervals for the development of diabetes with either measurement of fasting plasma glucose or a 2-hour oral glucose tolerance test.

For the prevention of CVD and T2DM, we recommend that priority be given to lifestyle management. This includes anti-atherogenic dietary modification, a program of increased physical activity, and weight reduction. Efforts to promote lifestyle modification should be considered an important component of the medical management of patients to reduce the risk of both CVD and T2DM.