Improving the management of systemic metabolic disorders: a clinical staging system from the European Atherosclerosis Society

Gothenburg May 7, 2025

Rising rates of obesity and metabolic disorders

Rates of obesity and related metabolic disorders have increased dramatically in recent years with serious consequences for the long-term health of the population worldwide. Although the interplay between the various metabolic disorders is increasingly recognized, current management strategies often target individual metabolic disorders, limiting the impact of treatment on risk reduction. The European Atherosclerosis Society (EAS) addresses this issue through a consensus statement that provides a clinically actionable framework based on the pathophysiology of the systemic metabolic disorders associated with excess adiposity. The framework takes a holistic approach to these disorders and is divided into three actionable stages to reflect the progression of the disease. It defines specific clinical criteria and provides management strategies for each stage.

Pathophysiology and risk factors

The primary driver of systemic metabolic disorders is sustained positive energy balance, which promotes fat storage in organs such as the liver, heart, muscle, pancreas, and kidneys, leading to insulin resistance and systemic inflammation. Genetic predisposition and socio-economic disparities further influence the likelihood of developing systemic metabolic disorders. Systemic metabolic disorders progress from metabolic abnormalities without organ damage (described as stage 1 in this statement) to early organ damage (stage 2) and further to late-stage organ disease (stage 3). This consensus article highlights the importance of treating systemic metabolic disorders at an early stage and aims to increase awareness among medical professionals that more than one organ might be affected. According to Co-Chair Professor Antonio Vidal-Puig (University of Cambridge, UK), ‘Collective assessment of interrelated risk factors is essential to enabling the earliest whole-body approach to prevention. Therefore, individuals with excess adiposity should be screened for multiple metabolic risk factors before evidence of disease progression.’

Clinical staging and prevalence

The staging system includes diagnostic criteria for each stage of systemic metabolic disorders. The EAS consensus panel used these criteria to determine the prevalence of systemic metabolic disorders in European participants of the UK Biobank and identified stage 1 in 58% and stage 2 in a further 19% of this population. Stage 2 conferred a 49% increase in all-cause mortality after adjustment for age and sex. ‘Given our results showing that over half of the UK Biobank population has stage 1 systemic metabolic disorders, clinical management should focus on reducing the number of individuals who develop systemic metabolic disorders and preventing the transition to stage 2 and beyond,’ commented Co-Chair Professor Stefano Romeo (Karolinska Institute, Stockholm, Sweden).

Management strategies

This EAS statement summarizes the key management strategies for systemic metabolic disorders, which are lifestyle modifications, pharmacotherapy, and metabolic surgery in severe cases. Co-Chair Professor Mansoor Husain (University of Toronto, Ontario, Canada) said: ‘Lifestyle changes should be encouraged as the cornerstone of management as they are effective at reducing metabolic risk factors at all stages of systemic metabolic disorders. In addition, each disorder should be treated with the appropriate pharmacotherapy, recognizing that multiple organs might be involved. It is also important to acknowledge the potential of GLP-1 receptor agonists to treat many of the components of systemic metabolic disorders.’

Immediate Past President of the EAS and consensus coordinator Professor Kausik Ray (Imperial College, London, UK) said, ‘This consensus is much needed and addresses the new frontier in cardiometabolic medicine. Here we provide a contextual framework for addressing this global public health challenge from pathophysiology to practical management strategies. The contextual framework if implemented aligns with our EAS mission to improve cardiovascular health globally.’

Clinical framework and long-term goals

The clinical staging framework presented in this EAS statement offers a pragmatic approach to diagnosing and treating systemic metabolic disorders, encouraging a proactive management strategy. The staging system enhances awareness of systemic metabolic disorders as a multisystem disorder and proposes therapeutic strategies to mitigate obesity-related comorbidities and thereby improve long-term health outcomes.

Reference

Romeo S, Vidal-Puig A, Husain M, Ahima R, Arca M, Bhatt DL, Diehl AM, Fontana L, Foo R, Frühbeck G, Kozlitina J, Lonn E, Pattou F, Plat J, Quaggin SE, Ridker PM, Rydén M, Segata N, Tuttle KR, Verma S, Roeters van Lennep J, Benn M, Binder CJ, Jamialahmadi O, Perkins R, Catapano AL, Tokgözoğlu L, Ray KK, on behalf of the European Atherosclerosis Society Consensus. Clinical staging to guide management of metabolic disorders and their sequelae: a European Atherosclerosis Society consensus statement.
Eur Heart J 2025: https://doi.org/10.1093/eurheartj/ehaf314

Contact

Contact: EAS Office
Dr Carmel Hayes
E-mail: [email protected]

Notes for editors and history of the EAS Consensus

For this article, the EAS Consensus Panel was co-chaired by Professor Stefano Romeo (Sweden), Professor Antonio Vidal-Puig (UK) and Professor Mansoor Husain (Canada) and comprised experts from Europe, North America, Asia and Australia.

The EAS Consensus Panel, comprising internationally renowned experts in atherosclerosis and cardiovascular disease, first convened in November 2009 to consider the evidence for non-LDL lipids as risk factors for cardiovascular disease. The Panel was originally co-chaired by Professor John Chapman (France) and Professor Henry N. Ginsberg (USA).

From 2021 to 2024, the EAS consensus programme was overseen by the coordinators Professor Alberico Catapano (Italy), Professor Lale Tokgözoğlu (Turkey) and Professor Kausik Ray (UK). From 2025 to 2028, the coordinators are Professor Christoph Binder (Austria), Professor Marianne Benn (Denmark), Professor Stefano Romeo (Sweden) and Dr Jeanine Roeters van Lennep (Netherlands).