Who should have cardiometabolic testing
The criteria are broader than most people expect, and the reason is a number: in a general adult population, measurable abnormality is the rule rather than the exception.
The base rate argument
Researchers analyzing the National Health and Nutrition Examination Survey for 2009 to 2016 defined optimal metabolic health as having all of the following without medication for any of them: waist circumference under 102 cm in men and 88 cm in women, fasting glucose under 100 mg/dL and hemoglobin A1c under 5.7%, blood pressure under 120 over 80, triglycerides under 150 mg/dL, and HDL cholesterol at or above 40 mg/dL in men and 50 mg/dL in women.
By that definition, 12.2% of American adults met a full definition of optimal metabolic health in the National Health and Nutrition Examination Survey for 2009 to 2016 — so roughly 88% of US adults did not. Fewer than one in three normal-weight adults met it. The figure fell to 8.0% among overweight adults and 0.5% among adults with obesity.
In the Padda Institute patient population the picture is starker still: fewer than 3% of patients overall, and fewer than 1% of chronic pain patients, meet the same definition of metabolic health. Those are practice-reported figures from our own population, not trial outcomes, and individual results vary.
A screening rule built on the assumption that abnormality is unusual will find it late. That is the whole argument for casting the net where this testing casts it.
The criteria
Any one of these is sufficient.
| Criterion | Why it is on the list |
|---|---|
| Over 50 with any cardiovascular risk factor | Vascular and small-fiber change is common and silent in this group |
| Over 70, regardless of risk factors | Peripheral artery disease and vestibular dysfunction both rise steeply with age |
| High blood pressure, treated or not | Damages small vessels and impairs autonomic blood pressure control simultaneously |
| Overweight, or a raised waist measurement at any weight | Metabolic health prevalence falls sharply with adiposity |
| Current or former smoker | The strongest single association with peripheral artery disease |
| Diabetes or prediabetes | Nerve and vessel injury begins while glucose still looks acceptable |
The age criterion, defended
Age alone qualifying strikes some people as over-inclusive. Two figures explain it. Peripheral artery disease measured by ankle-brachial index rose from roughly 5% of adults in their late forties to roughly 18% by the late eighties in the wealthier countries surveyed. And 35.4% of US adults aged 40 and over had vestibular dysfunction detectable on a simple standing-balance test, with symptomatic individuals carrying twelve times the odds of falling.
Neither is something a person notices happening to them. Both are measurable in an hour.
Symptoms that move someone up the list
You do not need symptoms to qualify. If any of these are present, the case for measuring rather than waiting is much stronger: burning or numbness in the feet, feet that have stopped sweating, cramping in the legs on walking, lightheadedness on standing, exercise intolerance out of proportion to fitness, or unsteadiness.
Who this is not for
Healthy adults under 50 with no risk factors, where the yield does not justify it. Anyone in an acute presentation — chest pain, sudden weakness, a cold and painful limb — who needs an emergency department. And anyone for whom the result could not change what happens next.
References
- Araújo J, Cai J, Stevens J. Prevalence of Optimal Metabolic Health in American Adults: National Health and Nutrition Examination Survey 2009–2016. Metabolic Syndrome and Related Disorders. 2019;17(1):46–52. doi:10.1089/met.2018.0105
- Fowkes FGR, Rudan D, Rudan I, et al. Comparison of global estimates of prevalence and risk factors for peripheral artery disease in 2000 and 2010: a systematic review and analysis. Lancet. 2013;382(9901):1329–1340. doi:10.1016/S0140-6736(13)61249-0
- Agrawal Y, Carey JP, Della Santina CC, Schubert MC, Minor LB. Disorders of balance and vestibular function in US adults: data from the National Health and Nutrition Examination Survey, 2001–2004. Archives of Internal Medicine. 2009;169(10):938–944. doi:10.1001/archinternmed.2009.66
Related reading
Medically reviewed by Dr. Gurpreet Singh Padda, MD, MBA, MHP, medical director of Measura. Last reviewed .