Who should have cardiometabolic testing

Cardiometabolic testing is for adults over 50 with any cardiovascular risk factor, everyone over 70, and anyone with high blood pressure, excess weight or a raised waist, a smoking history, or diabetes or prediabetes. Any one of these is enough.

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.

Why are the criteria for cardiometabolic testing so broad?

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, under 12.2% of American adults met it in 2009 to 2016, and under 7% do on the tighter criteria applied after 2021 — so more than nine in ten US adults do 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.

Who should get cardiometabolic testing?

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

Population criteria for cardiometabolic and autonomic assessment.

Why does age alone qualify you for testing?

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.

Do you need symptoms to get cardiometabolic testing?

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 does not need cardiometabolic testing?

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.

Frequently asked questions

What are the five markers of metabolic health?

Researchers using national survey data counted five: a waist under 102 cm for men and 88 cm for women, fasting glucose under 100 mg/dL with an A1c under 5.7%, blood pressure under 120 over 80, triglycerides under 150 mg/dL, and HDL cholesterol of at least 40 mg/dL in men and 50 mg/dL in women. All five have to be met without medication.

Can you be metabolically unhealthy at a normal weight?

Yes. In the national survey data behind these criteria, fewer than one in three normal-weight adults met every marker of metabolic health. Weight is only part of the picture, which is why a raised waist counts at any weight, and why high blood pressure, smoking, prediabetes or age can each qualify you for testing on their own.

How many American adults are metabolically healthy?

Very few. Under 12.2% of US adults met the full definition of metabolic health in the 2009 to 2016 survey years, and under 7% do on the tighter criteria applied after 2021. That means more than nine in ten adults miss at least one marker, which is why the testing criteria cast a wide net.

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