Prevention of Cardiovascular Disease
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Introduction
Epidemiologu:
- women & men of color are less likely to receive appropriate statin therapy than were non-Hispanic white men[12]
Management
- control of cardiovascular risk factor
- smoking cessation
- offer counseling for lifestyle interventions (healthy diet, exercise) for overweight adults at risk for cardiovascular disease[4]
- lifestyle interventions more effective than metformin for delaying progression of prediabetes to oververt diabetes mellitus type-2[13]
- counseling may be of some benefit to some patients without known cardiovascular risk factors (USPSTF, grade C recommenation)[5]
- statin for LDL cholesterol > 190 mg/dL or 10 year risk of cardiovascular disease of > 7.5% (AHA, ACC) > 10% (USPSTF)
- moderate intensity statin may be considered for
- persistent LDL cholesterol > 160 mg/dL
- family history of premature cardiovascular disease
- chronic kidney disease
- metabolic syndrome
- history of preeclampsia or premature menopause
- chronic inflammation
- HIV1 infection
- South Asian
- persistently elevated serum triglycerides > 175 mg/dL
- lipoprotein<a> > 50 mg/dL
- apolipoprotein B > 130 mg/dL
- ankle/brachial index < 0.9[13]
- niacin does increase HDL, but does not improve cardiovascular outcomes[13]
- fish consumption lowers cardiovascular risk only in patients with preexisting cardiovascular disease[6]
- no cardiovascular risk benefit of omega-3 fatty acids[10]
- soluble (viscous) fiber lowers LDL cholesterol & estimated 10-year cardiovascular risk[7][8][9]
- Mediterranean diet & low-fat diet reduce all-cause & cardiovascular mortality in persons with cardiovascular risk factors[11]
- low-dose aspirin may reduce risk of stroke at the expense of increased risk of hemorrhage[1]
More general terms
More specific terms
- prevention of ischemic stroke
- primary prevention of cardiovascular disease
- secondary prevention in patients with cardiovascular disease
Additional terms
References
- ↑ 1.0 1.1 Medical Knowledge Self Assessment Program (MKSAP) 16, American College of Physicians, Philadelphia 2012
- ↑ Wenger NK. Preventing cardiovascular disease in women: an update. Clin Cardiol. 2008 Mar;31(3):109-13 PMID: https://www.ncbi.nlm.nih.gov/pubmed/17803222
- ↑ Antithrombotic Trialists' (ATT) Collaboration, Baigent C et al Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trials. Lancet. 2009 May 30;373(9678):1849-60 PMID: https://www.ncbi.nlm.nih.gov/pubmed/19482214
- ↑ 4.0 4.1 U.S. Preventive Services Task Force (USPSTF) Behavioral Counseling to Promote a Healthy Diet and Physical Activity for Cardiovascular Disease Prevention in Adults with Known Risk Factors: U.S. Preventive Services Task Force Recommendation Statement. DRAFT. Summary of Recommendation and Evidence. http://www.uspreventiveservicestaskforce.org/draftrec.htm
- ↑ 5.0 5.1 US Preventive Services Task Force Behavioral Counseling to Promote a Healthful Diet and Physical Activity for Cardiovascular Disease Prevention in Adults Without Cardiovascular Risk Factors. US Preventive Services Task Force Recommendation Statement. JAMA. 2017;318(2):167-174 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28697260 <Internet> http://jamanetwork.com/journals/jama/fullarticle/2643315
Patnode CD, Evans CV, Senger CA, Redmond N, Lin JS. Behavioral Counseling to Promote a Healthful Diet and Physical Activity for Cardiovascular Disease Prevention in Adults Without Known Cardiovascular Disease Risk Factors: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2017;318(2):175-193 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28697259 <Internet> http://jamanetwork.com/journals/jama/fullarticle/2643314
Greenland P, Fuster V. Cardiovascular Risk Factor Control for All. JAMA. 2017 Jul 11;318(2):130-131. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28697239 <Internet> http://jamanetwork.com/journals/jama/fullarticle/2643292 - ↑ 6.0 6.1 Mohan D, Mente A, Dehghan M et al. Associations of fish consumption with risk of cardiovascular disease and mortality among individuals with or without vascular disease from 58 countries. JAMA Intern Med 2021 Mar 8; [e-pub] PMID: https://www.ncbi.nlm.nih.gov/pubmed/33683310 https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2777338
- ↑ 7.0 7.1 Salvado J, Jenkins DJA, Kendall CWC, Sievenpiper JL. Portfolio Dietary Pattern and Cardiovascular Disease: A Systematic Review and Meta-analysis of Controlled Trials. Prog Cardiovasc Dis. 2018 May-Jun;61(1):43-53 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29807048 Review
- ↑ 8.0 8.1 Surampudi P, Enkhmaa B, Anuurad E, Berglund L. Lipid Lowering with Soluble Dietary Fiber. Curr Atheroscler Rep. 2016 Dec;18(12):75. PMID: https://www.ncbi.nlm.nih.gov/pubmed/27807734 Review.
- ↑ 9.0 9.1 Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022
- ↑ 10.0 10.1 Wendling P. No CVD Benefit With Omega-3 Fatty Acids Medscape. Feb 02, 2018. https://www.medscape.com/viewarticle/892201
Aung T, Halsey J, Kromhout D, et al. Associations of omega-3 fatty acid supplement use with cardiovascular disease risks: meta-analysis of 10 trials involving 77,917 individuals. JAMA Cardiol. January 31, 2018 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29387889 https://jamanetwork.com/journals/jamacardiology/fullarticle/2670752 - ↑ 11.0 11.1 Karam G et al. Comparison of seven popular structured dietary programmes and risk of mortality and major cardiovascular events in patients at increased cardiovascular risk: Systematic review and network meta-analysis. BMJ 2023 Mar 29; 380:e072003. PMID: https://www.ncbi.nlm.nih.gov/pubmed/36990505 PMCID: PMC10053756 Free PMC article https://www.bmj.com/content/380/bmj-2022-072003
- ↑ 12.0 12.1 Frank DA et al. Disparities in guideline-recommended statin use for prevention of atherosclerotic cardiovascular disease by race, ethnicity, and gender: A nationally representative cross-sectional analysis of adults in the United States. Ann Intern Med 2023 Jul 25; [e-pub]. PMID: https://www.ncbi.nlm.nih.gov/pubmed/37487210 https://www.acpjournals.org/doi/10.7326/M23-0720
- ↑ 13.0 13.1 13.2 13.3 NEJM Knowledge+
Stone NJ, Robinson JG, Lichtenstein AH et al 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014 Jun 24;129(25 Suppl 2):S1-45. PMID: https://www.ncbi.nlm.nih.gov/pubmed/24222016 Free article.
Knowler WC, Barrett-Connor E, Fowler SE et al Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002 Feb 7;346(6):393-403. doi:http://dx.doi.org/ 10.1056/NEJMoa012512. PMID: https://www.ncbi.nlm.nih.gov/pubmed/11832527 PMCID: PMC1370926 Free PMC article. Clinical Trial.