Clinical staging to guide management of metabolic disorders and their sequelae: a European Atherosclerosis Society consensus statement
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
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. The staging system provides a structured approach to understanding and addressing the multi-faceted nature of SMD, which is crucial for improving health outcomes. Categorization of SMD abnormalities by presence and progression is aimed to improve awareness of a multi-system trait and encourage a tailored and global approach to treatment, ultimately aiming to reduce the burden of obesity-related comorbidities.
Date Issued
2025-10-07
Date Acceptance
2025-05-01
Citation
European Heart Journal, 2025, 46 (38), pp.3685-3713
ISSN
0195-668X
Publisher
Oxford University Press
Start Page
3685
End Page
3713
Journal / Book Title
European Heart Journal
Volume
46
Issue
38
Copyright Statement
© The Author(s) 2025. Published by Oxford University Press on behalf of the European Society of Cardiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.
License URL
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/40331343
PII: 8125503
Subjects
ADIPOSE-TISSUE
BODY-MASS INDEX
Cardiac & Cardiovascular Systems
Cardiovascular System & Cardiology
CARDIOVASCULAR-DISEASE
CORONARY-HEART-DISEASE
C-REACTIVE PROTEIN
FATTY LIVER-DISEASE
Heart failure
Insulin resistance/pre-diabetes
INSULIN-RESISTANCE
INTENSIVE MEDICAL THERAPY
Kidney disease
Life Sciences & Biomedicine
MASLD
Obesity
PRESERVED EJECTION FRACTION
Science & Technology
TRIGLYCERIDE-RICH LIPOPROTEINS
Type 2 diabetes
Publication Status
Published
Coverage Spatial
England
Date Publish Online
2025-05-07