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Prevention of Cardiovascular Disease

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 - rheumatoid arthritis, psoriasis - serum C-reactive protein > 3.0 mg/L - HIV1 infection - South Asian - persistently elevated serum triglycerides > 175 mg/dL - lipoprotein > 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]

Related

cardiovascular disease (CVD) cardiovascular risk factor

Specific

prevention of ischemic stroke primary prevention of cardiovascular disease secondary prevention in patients with cardiovascular disease

General

prophylaxis (prevention, ppx)

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 16, American College of Physicians, Philadelphia 2012
  2. Wenger NK. Preventing cardiovascular disease in women: an update. Clin Cardiol. 2008 Mar;31(3):109-13 PMID: 17803222
  3. 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: 19482214
  4. 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. 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 PMID: 28697260 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 PMID: 28697259 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. PMID: 28697239 http://jamanetwork.com/journals/jama/fullarticle/2643292
  6. 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: 33683310 https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2777338
  7. 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: 29807048 Review
  8. Surampudi P, Enkhmaa B, Anuurad E, Berglund L. Lipid Lowering with Soluble Dietary Fiber. Curr Atheroscler Rep. 2016 Dec;18(12):75. PMID: 27807734 Review.
  9. Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022
  10. 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: 29387889 https://jamanetwork.com/journals/jamacardiology/fullarticle/2670752
  11. 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: 36990505 PMCID: PMC10053756 Free PMC article https://www.bmj.com/content/380/bmj-2022-072003
  12. 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: 37487210 https://www.acpjournals.org/doi/10.7326/M23-0720
  13. 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: 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: 10.1056/NEJMoa012512. PMID: 11832527 PMCID: PMC1370926 Free PMC article. Clinical Trial.