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

作者：Stefano Romeo, Antonio Vidal‐Puig, Mansoor Husain, Rexford S. Ahima, Marcello Arca, Deepak L Bhatt, Anna Mae Diehl, Luigi Fontana, Roger Foo, Gema Frühbeck, Julia Kozlitina, Eva Lonn, François Pattou, Jogchum Plat, Susan E. Quaggin, Paul M. Ridker, Mikael Rydén, Nicola Segata, Katherine R Tuttle, Subodh Verma, Jeanine E. Roeters van Lennep, Marianne Benn, Christoph J. Binder, Oveis Jamialahmadi, Rosie Perkins, Alberico L. Catapano, Lâle Tokgözoğlu, Kausik K. Ray, the European Atherosclerosis Society Consensus, Ralph Kwame Akyea, Pablo Corral, Judy de Haan, Dagmar Kratky, Margus Viigimaa, Belma Pojskić, Phivos Symeonides, Michal Vrablik, Ashraf Reda, Märt Elmet, Minna Kaikkonen-Määttä, René Valéro, Tea Gamezardashvili, Ulrike Schatz, Oliver Weingärtner, Daniel Sedding, Haralampos Milionis, Christodoulos Papadopoulos, György Paragh, Mutaz Al-Khnifsawi, Vincent Maher, Alberico L. Catapano, Jaetaek Kim, Erkin М Мirrakhimov, Juan Eduardo Garcia Garcia, John Valdes, Dan Gaiță, Roxana Cristina Rimbaş, М. В. Ежов, Carlos Guijarro Herráiz, Habib Gamra, Tomasz J Guzik, Olena Mitchenko · 发表于：European Heart Journal · 年份：2025 · DOI：10.1093/eurheartj/ehaf314 · 被引用次数：69 · 研究领域：Diet and metabolism studies、Diabetes, Cardiovascular Risks, and Lipoproteins、Diabetes Treatment and Management

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. ...