ASPC Manual of Preventive Cardiology

Foreword
References
Preface
Acknowledgements
Contents
Contributors
Focus on Cardiovascular Health Promotion and Disease Prevention: Opportunities for Improvement
1 Introduction
2 Defining Cardiovascular Health
3 Bucket 1: Traditional Clinical Prevention
3.1 Improvement in Utilization and Adherence to Guideline-Recommended Therapies
3.2 Improving Utilization of Cardiac Rehabilitation
3.3 Improving Identification and Treatment of Familial Hypercholesterolemia
4 Bucket 2: Innovative Clinical Prevention
4.1 New Care Models
4.2 Improving Risk Assessment and Treatment of Cardiovascular Disease
4.3 Improving Partnerships and the Use of Registries
5 Bucket 3: Community-Wide Prevention
5.1 Public Policy
5.2 Public Health Initiatives
5.3 Mass Media Campaigns
5.4 Environmental Interventions
5.5 School-Based Interventions
5.6 Workplace Interventions
6 Conclusion
References
National and Global Trends of Cardiovascular Disease Mortality, Morbidity, and Risk
1 Introduction
2 Overall Cardiovascular Disease Mortality and Morbidity
2.1 Cardiovascular Disease Mortality
2.2 Cardiovascular Disease Morbidity
3 Mortality and Morbidity Attributable to CVD Subtypes in the USA
3.1 Coronary Heart Disease
3.2 Stroke and Transient Ischemic Attack
3.3 Heart Failure
3.4 Hypertension
3.5 Other Cardiovascular Disease
4 Prevalence of Ideal Cardiovascular Health Factor Levels
5 Global Burden of Cardiovascular Disease
6 Conclusion
References
Cardiovascular Risk Assessment: From Global Risk Scoring to Risk Enhancing Factors
1 Introduction
2 The High-Risk Approach and Shifting Toward Risk Assessment Equations
2.1 Shifting from Risk Factors to Multivariable Risk Assessment Models
3 Using the Pooled Cohort Equations to Assess Cardiovascular Risk
4 Limitations of the Pooled Cohort Equation
4.1 Populations with Lower or Higher CVD Incidence Rates
4.2 Young Populations and When to Assess Long-Term or Lifetime Risk
4.3 Risk Assessment in Elderly Populations
5 Using Risk Enhancing Factors to Calibrate Risk Assessment
6 Alternative Tools for Risk Assessment
7 Risk Factors Not Represented in Risk Assessment Tools
8 Summary of the ACC/AHA and ESC Guidelines
8.1 ACC/AHA 2019 Primary Prevention Guidelines
8.2 ESC 2016 Cardiovascular Disease Prevention Guidelines
9 Conclusion
References
Assessment and Management of Psychosocial Risk Factors Within Preventive Cardiology Practice
1 Introduction
2 Psychosocial Risk Factors
2.1 Depression
2.2 Anxiety Syndromes
2.3 Lack of Social Connectivity
2.4 Pessimism
2.5 Hostility
2.6 Other Negative Cognitive States
2.7 Lack of Life Purpose
2.8 Vitality Exhaustion
2.9 Chronic Stress
3 Positive Psychosocial Functioning
4 Pathophysiological Mechanisms
5 Management of Psychosocial Risk Factors in Preventive Cardiology
5.1 Screening
5.2 Tiered Management of Patients
5.3 First Tier: Personal Physician Management
5.4 Second Tier: Invoking Office Personnel, Community Programs, or Hospital-Based Programs
5.5 Third Tier: Referral to Qualified Mental Health Professionals
6 Conclusion
References
Dietary Strategies for Atherosclerotic Cardiovascular Risk Reduction
1 Introduction
2 ACC/AHA Nutrition and Diet Recommendations for ASCVD Prevention
3 ACC/AHA Nutrition and Diet Recommendations for Adults with Overweight and Obesity
4 ACC/AHA Nutrition Recommendations for Adults with Type 2 Diabetes
5 Nutrition Recommendations for the Prevention and Treatment of Hypertension
6 ACC, AHA, and National Lipid Association (NLA) Nutrition Goals for Optimizing LDL-C and Non-HDL-C and Reducing ASCVD Risk
7 Criteria for Nutritional Indicators for Dyslipidemia and Cardiometabolic Risk Factors
8 Heart-Healthy Dietary Patterns for Reducing LDL-C, Non-HDL-C, and ASCVD Risk
8.1 DASH Dietary Pattern
8.2 Mediterranean-Style Dietary Pattern (Healthy US-Style Food Pattern)
8.3 Vegetarian/Vegan Dietary Pattern (Plant-Based Dietary Patterns)
9 Low Fat Versus Low Carbohydrate and Very Low Carbohydrate (Including Ketogenic Diets for Overweight/Obesity, Dyslipidemia, Metabolic Syndrome, Diabetes, Inflammation, and ASCVD Risk)
10 Nutrition and Lifestyle Recommendations for Triglyceride Reduction
11 Saturated Fats, Trans Fats, Omega-3, Omega-6, and Monounsaturated Fats
12 Fish Intake
13 Dietary Cholesterol
14 Dietary Adjuncts: Viscous Fiber, Phytosterols, Dietary Supplements, and Probiotics
14.1 Viscous Fiber
14.2 Phytosterols
14.3 Nutraceuticals/Dietary Supplements
14.4 Probiotics
15 Referral to a Registered Dietitian-Nutritionist (RDN) in a Team-Based Collaborative Care Approach for the Prevention and Treatment of ASCVD Risk Factors
15.1 Role of the Registered Dietitian-Nutritionist (RDN)
15.2 Referral to a Multidisciplinary Lipid Clinic or a Preventive Cardiology Clinic/Program
15.3 Referral to a Comprehensive Lifestyle Weight Management Program
16 Alcohol
17 Conclusion
Appendix A: American Heart Association-Recommended Dietary Pattern Based on Dietary Approaches to Stop Hypertension Feeding Trials (DASH)a [17]
Appendix B: Types and Sources of Fats and Their Effect on Serum Lipids [1–3]
Appendix C: Summary of Selected Nutraceuticals/Dietary Supplements for LDL-C Reduction Along with Class and Level of Evidence by an International Expert Panel [44]
References
Diet Resources
American College of Cardiology
American Heart Association
Academy of Nutrition and Dietetics
National Lipid Association
Physical Activity Strategies
1 Introduction
2 Epidemiologic Studies
3 Cardiovascular Impact of Regular Physical Activity: Potential Underlying Mechanisms
3.1 Benefits of Vigorous Versus Moderate-Intensity Physical Activity
4 Cardiorespiratory Fitness and Physical Activity as Separate Coronary Heart Disease Risk Factors: Comparative Benefits
4.1 Impact of CRF on Mortality and Other Health Outcomes
5 Exercise Prescription/Programming
5.1 The Concept of Oxygen Consumption Reserve (VO2R)
5.2 Exercise Modalities/Training Intensities
5.3 Contemporary PA Recommendations
6 Progression of Exercise Training Intensities for Optimal Cardiovascular Benefits
6.1 Energy Expenditure of Graded Treadmill Walking: Rule of 2 and 3 mph
6.2 Using the Heart Rate Index Equation to Estimate METs During Exercise
6.3 Evolution of Personalized Activity Intelligence
7 Complementary Training Modalities/Techniques
7.1 Upper Body Training
7.2 Resistance Training
7.3 Lifestyle or Incidental Physical Activity
7.4 High-Intensity Interval Training (HIIT)
8 High-Volume, High-Intensity Endurance Training and Potential Adverse Cardiovascular Outcomes: Too Much of a Good Thing?
9 Using Technology to Promote Physical Activity
10 Strategies to Enhance Adherence to Physical Activity
11 Conclusions
References
Obesity Management and Prevention of Cardiovascular Disease
1 Introduction
1.1 An Increase in Obesity
1.2 The Cost of Obesity
1.3 Measures of Obesity: Body Mass Index
1.4 Measures of Obesity: Waist Circumference
1.5 Measures of Obesity: Additional Tools
2 Obesity and Heart Disease
2.1 Background
2.2 Mechanisms for Obesity and CVD
2.3 Benefits of Weight Loss
3 Obesity Management
4 Dietary Approach
4.1 Dietary Strategies for Weight Loss
4.2 Studies Assessing Various Diets
4.3 Dietary Recommendations
5 Physical Activity
5.1 Physical Activity Gaps
5.2 Aerobic Training Guidelines and Benefits
5.3 Strength Training Guidelines and Benefits
5.4 Weight Loss and Maintenance
6 Medications
6.1 Indications for Medications
6.2 Medication Effects and Options
6.3 Medication Considerations in CVD and Type 2 Diabetes
7 Surgical Management of Obesity
7.1 Surgical Options
7.2 Surgical Weight Loss Outcomes
7.3 Surgical Benefits
7.4 Surgical Complications
7.5 Endoscopic Bariatric Procedures
8 Conclusion
References
Smoking and Vaping
1 Introduction
2 Smoking and Cardiovascular Disease
3 Secondhand Smoke
4 Trends in Cigarette Smoking
5 Prevention and Reduction of Tobacco Use Among Youth
6 Prevention and Cessation Programs for Adults
7 Cessation Strategies for Individuals
7.1 Behavioral Treatments
7.2 Pharmacologic Interventions
7.3 Clinical Approaches
8 Conclusions
References
Alcohol and Cardiovascular Diseases
1 Alcoholic Cardiomyopathy
2 Hypertension: A Threshold Issue
3 Supraventricular Arrhythmias
4 Atherosclerotic Coronary Disease: Protection by Alcohol
4.1 Epidemiology: A J-Curve Relationship
4.2 Plausible Mechanisms for Lower CAD Risk in Drinkers
4.3 Genetic Polymorphism Data
5 Drinking Pattern: A Crucial Factor
6 Beverage Choice: Wine, Liquor, or Beer?
7 Alcohol and CAD: Is It Causal?
8 Cerebrovascular Disease: The Epidemiologic Labyrinth
9 Heart Failure (HF): It Depends on the Cause
10 Conclusions
References
The 2018 AHA/ACC/Multisociety Cholesterol Guidelines: A Personalized Approach to Risk Reduction
1 Introduction
2 Key Concepts
2.1 Personalization of Risk Assessment and Treatment Plan
2.2 Begin with Lifestyle Intervention
3 Secondary Prevention
3.1 Statins as First-Line Therapy in Secondary Prevention
3.2 Non-statin Therapy for Patients with ASCVD at Very High Risk
3.3 Secondary Prevention in Adults >75 Years of Age
4 Primary Prevention
4.1 Risk Assessment Is the Initial Step in Primary Prevention
4.2 Statin Therapy for High-Risk Primary Prevention
4.3 Using Risk Enhancers to Personalize Risk
4.4 Reclassifying Risk with Coronary Artery Calcium Scoring
5 Special Populations to Consider
5.1 Hypertriglyceridemia
5.2 Sex and Race Considerations
5.3 Primary Prevention in Adults >75 Years of Age
5.4 Children and Adolescents
5.5 Other Special Populations
6 Conclusion
References
Blood Pressure and Hypertension Management
1 Introduction
2 Definition of High Blood Pressure
3 New Blood Pressure Target Recommendations
4 Diabetes and Hypertension
4.1 Generalizability of Clinical Trials and Patient-Centered Approach
5 Strategies for Hypertension Management
5.1 Blood Pressure Measurement
5.2 Debate on Blood Pressure Measurement
5.3 Ambulatory Blood Pressure Monitoring (ABPM)
5.4 Therapeutic Lifestyle Changes
5.5 Pharmacologic Treatment
6 Combination Therapy
6.1 Drug Resistant Hypertension
6.2 Fixed-Drug or Polypill Antihypertensive Combinations
6.3 Emerging Issues for Reducing CV Risk in Patients with Diabetes
7 Potential Strategies for Improving Medication Adherence to Achieve Effective Blood Pressure Control
8 Conclusion
References
Cardiodiabetology: Reducing Risks to Optimize Cardiovascular Disease Outcomes
1 Introduction
2 Epidemiology of Diabetes and Cardiovascular Disease
3 Cardiovascular Risk Assessment in Diabetes
4 Evidence for Multiple Risk Factor Control to Reduce Cardiovascular Risk
5 Cardiovascular Risk Management in Diabetes
6 Lifestyle Management
7 Blood Pressure Control
8 Cholesterol and Lipid Management
9 Newer Diabetes Therapies and CVD Risk Reduction
10 Guidelines for Glycemic Control
11 Aspirin Therapy
12 The Cardiodiabetes Care Team
13 Conclusions
References
Antiplatelet Therapy
1 Introduction
2 Aspirin
2.1 Mechanism of Action
2.2 Secondary Prevention
2.3 Primary Prevention
2.4 Dosing
2.5 Formulations
2.6 Hemorrhagic Complications
2.7 Drug Interactions
2.8 Aspirin Resistance
3 Platelet P2Y12 Receptor Antagonists
3.1 Mechanism of Action
3.2 Ticlopidine
4 Clopidogrel
4.1 Secondary Prevention
4.2 Clopidogrel Resistance
5 Prasugrel
5.1 Guidelines
6 Ticagrelor
7 Cilostazol
8 Dipyridamole
9 Rivaroxaban
10 Conclusion
References
Inflammation and Atherosclerotic Cardiovascular Disease
1 Introduction
2 Endothelial Function/Dysfunction
3 Inflammatory Blood Cells and Atherogenesis
3.1 Monocytes and Macrophages
3.2 T Lymphocytes
3.3 Mast Cells
3.4 Neutrophils
3.5 Platelets
4 Adipose Tissue and Adipokines
5 MicroRNAs and Inflammation
6 Inflammation and Increased Oxidative Tone
7 Microbiome and Inflammation
8 Cardiovascular Biomarkers of Inflammation
8.1 High Sensitivity C-Reactive Protein
8.2 Lipoprotein-Associated Phospholipase A2
8.3 Myeloperoxidase
9 Therapeutic Modulation of Systemic Inflammation
10 Intrinsic Resolution of Inflammation
11 Conclusions
References
The Role of Genetics in Preventive Cardiology: Utility of Clinically Available Genetic Tests
1 Introduction
1.1 History
2 Genetic Tests Help to Fill an Unmet Clinical Need
2.1 Noninvasive Imaging and Genetics
3 Specific Genetic Tests and Unmet Clinical Need
3.1 Cholesterol Unmet Clinical Need
3.2 9p21 Primary Prevention Risk Reclassification
3.3 9p21
3.4 Primary Prevention: The Aspirin (ASA) Conundrum
3.5 Secondary Prevention: Lp(a) Phenotype
3.6 Arrhythmia
3.7 Atrial Fibrillation (AF)
3.8 Sudden Cardiac Death (SCD) and Pathogenic Arrhythmias
3.9 Cardiomyopathy
3.10 Dyslipidemia
3.11 Hypercholesterolemia
3.12 ApoE Genotype
3.13 LDLR Genotype
3.14 APOB Genotype
3.15 Proprotein Convertase Subtilisin/Kexin Type 9 (PCSK9) Genotype
3.16 Sitosterolemia
3.17 Polygenic Lipid Disorder Testing
4 Conclusions
References
Exercise Electrocardiographic Stress Testing
1 Introduction
2 Exercise Physiology and the Cardiac Response
3 Indications for Exercise Testing
4 Administration of Exercise Electrocardiography
5 Detection of Exercise-Induced Myocardial Ischemia
6 Exercise-Induced ST-Segment Elevation
7 Pretest Probability of Disease and Bayes’ Theorem
8 Exercise Electrocardiography in Women
9 Exercise Electrocardiography in Chest Pain Units
10 Non-exercise Electrocardiographic Test Variables
10.1 Heart Rate
10.2 Blood Pressure
10.3 Double Product
10.4 Functional Capacity
10.5 Prognostic Scores
10.6 Heart Rate Recovery
10.7 Combined Predictive Factors
11 Conclusions
References
Ultrasound and MRI Assessment of Cardiovascular Risk
1 Introduction
2 Ultrasound
2.1 Definition of CIMT
2.2 Definition of Plaque
2.3 CIMT Imaging and Measurement
2.4 Plaque Imaging
2.5 Plaque Quantification
2.6 Plaque Characterization
2.7 CIMT and Cardiovascular Risk Factors
2.8 CIMT and Cardiovascular Events
2.9 CIMT and Risk Prediction
3 CIMT in Younger Age and Other Populations
3.1 Carotid Plaque and Cardiovascular Events
3.2 Carotid Plaque and Risk Prediction
3.3 Advantages of Carotid Ultrasound
3.4 Limitations of Carotid Ultrasound
4 Role of Carotid Ultrasound in Clinical Practice
5 Magnetic Resonance Imaging (MRI)
5.1 Plaque Characterization
5.2 Intraplaque Hemorrhage (IPH)
5.3 Fibrous Cap
5.4 Lipid-Rich Necrotic Core (LRNC)
5.5 Calcification
5.6 Accuracy and Reproducibility of MR Imaging
5.7 MRI, Clinical Outcomes, and Risk Prediction
5.8 Advantages of MRI
5.9 Limitations of MRI
6 Conclusion
References
Role of CT Coronary Calcium Scanning and Angiography in Evaluation of Cardiovascular Risk
1 Introduction
2 Atherosclerosis and CAD
3 Non-contrast Coronary CT: Assessment of Coronary Artery Calcification
4 Methods of Assessing Coronary Artery Calcium
4.1 Modality for Coronary Artery Calcium Determination
4.2 Measurement/Scoring of Coronary Artery Calcium Burden
5 Clinical Value of CAC on Assessing Cardiovascular Risk in Asymptomatic Individuals
5.1 Independent Association of CAC with Risk of Future CV Events
5.2 Incremental Value of CAC to Traditional Risk Factors for CV Risk Prediction
5.3 Absence of Coronary Artery Calcification
5.4 Who Should Be Screened with Non-contrast Coronary CT Among Asymptomatic Individuals?
5.5 Medication Compliance Following CAC Scanning
6 Coronary Computed Tomography Angiography for Assessing Cardiovascular Risk
7 Image Acquisition
8 Image Interpretation
9 Radiation Dose
10 Diagnostic Accuracy of CTA for Detection of Obstructive CAD
11 Prognostic Value of CTA in Prediction of CV Outcomes
12 Association of CTA-Detected Plaque Subtypes with Traditional Risk Factors
13 Prognostic Value of CTA-Detected Plaque Subtypes with Cardiovascular Disease Outcomes
14 Use of Quantitative CT Coronary Plaque Analysis to Study Effects of Therapy on Plaque Progression in Clinical Trials
15 Conclusion
References
Cardiovascular Disease Prevention in Women
1 Introduction
2 Perception of Cardiovascular Diseases Among Women
3 Cardiovascular Disease Risk Factors
3.1 Traditional Risk Factors
3.2 Female-Specific Risk Factors
3.3 Female-Predominant Risk Factors
4 ASCVD Risk Assessment
5 Future Directions
6 Recommendations
7 Conclusions
References
Racial/Ethnic Considerations in the Prevention of Cardiovascular Disease
1 Introduction
2 Social Determinants of Health and ASCVD Risk
3 Health Behaviors
3.1 Smoking
3.2 Physical Inactivity
3.3 Dietary Eating Patterns
3.4 Sleep
3.5 Nonadherence
4 ASCVD Risk Factors
4.1 Hypertension
4.2 Type 2 Diabetes
4.3 Hypercholesterolemia
4.4 Overweight/Obesity
5 Race/Ethnicity and Atherosclerotic Cardiovascular Disease Outcomes
5.1 Coronary Heart Disease
5.2 Heart Failure
5.3 Cerebrovascular Disease
5.4 Atrial Fibrillation
5.5 Peripheral Vascular Disease
6 Genetic Determinants of ASCVD Risk by Race/Ethnicity
7 Conclusion
References
Prevention of Heart Failure
1 Introduction
2 Epidemiology of Heart Failure
3 Evidence-Based Strategies to Prevent Heart Failure
3.1 Preventing New Onset Heart Failure: Intervening at Stage A
3.1.1 Life’s Simple 7™
Hypertension
Diabetes Mellitus
Smoking
Diet-Based Prevention
Obesity
Physical Activity
3.1.2 Preventing New-Onset Heart Failure: Intervening at Stage B
Left Ventricular Hypertrophy
Asymptomatic Left Ventricular Systolic Dysfunction
Post-Myocardial Infarction without Clinical Heart Failure
3.1.3 Preventing Heart Failure Morbidity and Mortality: Intervening at Stage C
Pharmacological Approaches
ACE Inhibitors
Angiotensin Receptor Blockers
Beta-Blockers
Aldosterone Antagonists
Angiotensin Receptor Blockade with Neprilysin Inhibition (ARNI)
Sodium-Glucose Cotransporter-2 (SGLT-2) Inhibitors
Hydralazine-Isosorbide Dinitrate Combination
Diuretics
Hypertension Management in Patients with Stage C Disease
Nonpharmacological Approaches
Implantable Cardioverter Defibrillators
Exercise Training
Diet and Dietary Supplementation
4 Biomarkers as Targets for Heart Failure Prevention
5 Role of Immunization as Strategy to Prevent Heart Failure
6 Cardiotoxins
6.1 Alcohol
6.2 Chemotherapeutic Agents
6.3 Nonsteroidal Anti-inflammatory Drugs (NSAIDs)
7 The Future of Heart Failure Prevention
8 Conclusion
References
Prevention of Peripheral Arterial Disease
1 Introduction
2 Risk Factors for PAD
2.1 Nonmodifiable Risk Factors
2.1.1 Age
2.1.2 Gender
2.1.3 Ethnicity
2.2 Behavioral Risk Factors
2.2.1 Cigarette Smoking
2.2.2 Physical Activity
2.3 Comorbidities
2.3.1 Hypertension
2.3.2 Hyperlipidemia
2.3.3 Diabetes Mellitus
2.3.4 Chronic Kidney Disease
2.4 Novel Risk Factors
2.4.1 Genetics
3 Prevention
3.1 Primary Prevention
3.1.1 Screening
3.1.2 Diet and Nutrition
3.1.3 Physical Activity
3.1.4 Smoking Cessation
3.1.5 Lipid Management
3.1.6 Blood Pressure Control
3.1.7 Glucose Control
3.2 Secondary Prevention
3.2.1 Diagnosis
3.3 Risk Factor Modifications
3.3.1 Smoking Cessation
3.3.2 Physical Activity
4 Pharmacotherapy for Management of Co-morbidities
4.1 Antiplatelet Therapy
4.2 Statin Therapy
4.3 Non-statin Lipid Lowering Therapy
4.4 Oral Anticoagulation
4.5 Glycemic Agents
4.6 Other Agents
4.7 Invasive Treatments
5 Conclusion
References
Prevention of Atrial Fibrillation
1 Introduction
1.1 Epidemiology
1.2 Secular Trends
1.3 Outcomes and Public Health Burden
2 Primordial, Primary, and Secondary Prevention of AF
2.1 Definitions
2.2 Typically Non-modifiable Risk Factors
2.2.1 Age
2.2.2 Sex
2.2.3 Race
2.3 Primordial Prevention
2.3.1 Weight
2.3.2 Nutritional Factors
2.3.3 Physical Activity
2.3.4 Smoking
2.3.5 Alcohol
2.3.6 Psychological and Psychosocial Factors
2.3.7 Social and Socioeconomic Factors
2.4 Primary Prevention
2.5 Elevated Blood Pressure and Hypertension
2.5.1 Diabetes Mellitus
2.5.2 Sleep Apnea
2.5.3 Chronic Kidney Disease
2.5.4 Bidirectional Nature Between AF and Comorbidities
Myocardial Infarction
2.5.5 Heart Failure
2.5.6 Stroke
2.5.7 Venous Thromboembolism
2.6 Secondary Prevention
3 Conclusions
References
Prevention of Ischemic Stroke
1 Introduction
2 Determinants of Stroke Etiology
3 Primary Prevention of Ischemic Stroke by Risk Factor
3.1 Hypertension
3.1.1 Definition and Epidemiology
3.1.2 What Is the Evidence?
3.1.3 Recommendations for Management
3.2 Dyslipidemia
3.2.1 Definition and Epidemiology
3.2.2 What Is the Evidence?
3.2.3 Recommendations for Management
3.3 Diabetes Mellitus
3.3.1 Definition and Epidemiology
3.3.2 What Is the Evidence?
Selection of Antihyperglycemic Agents
3.3.3 Recommendations for Management
3.4 Obesity and Metabolic Syndrome
3.4.1 Definition and Epidemiology
3.4.2 What Is the Evidence?
3.4.3 Recommendations for Management
3.5 Physical Inactivity
3.5.1 Definition and Epidemiology
3.5.2 What Is the Evidence?
3.5.3 Recommendations for Management
3.6 Nutrition and Diet
3.6.1 Definition and Epidemiology
3.6.2 What Is the Evidence?
3.6.3 Recommendations for Management
3.7 Tobacco Use
3.7.1 Definition and Epidemiology
3.7.2 What Is the Evidence?
3.7.3 Recommendations for Management
3.8 Alcohol Consumption
3.8.1 Definition and Epidemiology
3.8.2 What Is the Evidence?
3.8.3 Recommendations for Management
3.9 Atrial Fibrillation
3.9.1 Definition and Epidemiology
3.9.2 What Is the Evidence?
Selection of Anticoagulant Therapy
Nonpharmacologic Therapy: Percutaneous Left Atrial Appendage (LAA) Closure
3.9.3 Recommendations for Management
4 Aspirin for the Primary Prevention of Ischemic Stroke
4.1 Recommendations for Management
5 Antiplatelet Therapy for the Prevention of Recurrent Noncardioembolic Ischemic Strokes
6 Conclusion
References
Prevention of Cardiovascular Disease in Patients with Chronic Kidney Disease
1 Introduction
2 Epidemiology of CKD and Its Association with CVD
2.1 General CKD and CV Mortality
2.2 CKD and Coronary Artery Disease (CAD)
2.3 CKD and Congestive Heart Failure (CHF)
2.4 CKD and Valvular Heart Disease
2.5 CKD and Stroke
2.6 CKD and Peripheral Arterial Disease (PAD)
2.7 CKD and Non-valvular Atrial Fibrillation (AF)
2.8 CKD and Sudden Cardiac Death (SCD)
3 The Pathophysiology of CVD in CKD
4 Risk Stratification for CVD in CKD
5 Strategies for Prevention of CVD in Non-dialysis CKD
5.1 Interventions in Established CKD That Slow Progression or Reduce CVD Risk or Both
6 Conclusions
References
Primary Prevention of Cardiovascular Disease Guidelines
1 Introduction
2 Assessment of Risk
3 Aspirin
4 Blood Pressure
5 Cholesterol
5.1 Shared Decision-Making: CAC and Risk-Enhancing Factors as Tie-Breakers
5.2 LDL-C Assessment
6 Cigarettes
7 Diabetes
7.1 Diet and Exercise
7.2 Diabetes Medications
8 Diet and Weight
9 Exercise
10 Economic and Social Factors
11 Omega-3 Fatty Acids
12 Conclusions
References
Secondary Prevention and Cardiac Rehabilitation
1 Introduction
1.1 Burden of Cardiovascular Diseases
2 Secondary Prevention
2.1 US and European Guidelines
2.2 Pharmacotherapy Optimization
2.3 Physical Activity
2.4 Exercise Training
2.5 Nutrition
2.6 Psychosocial Factors
3 Cardiac Rehabilitation
3.1 US and European Guidelines
3.2 Phase I
3.3 Phase II
3.3.1 Standard CR
3.3.2 Intensive Phase II Programs
3.4 Phase III
3.5 Supporting Clinical Data
3.6 Referrals, Attendance, and Adherence
4 Future Directions
5 Conclusions
References
Integrative Approaches for Cardiovascular Disease Prevention
1 Introduction
2 Integrative Approaches to Primary and Secondary Prevention: Definition and Principles
3 Role of Nutrition and Lifestyle Approaches
4 Nutraceuticals
4.1 Primary Prevention: Dyslipidemia, Hypertension, and Insulin Resistance/Diabetes
4.1.1 Dyslipidemia
4.1.2 Hypertension
4.1.3 Insulin Resistance/Diabetes
4.2 Secondary Prevention: Coronary Artery Disease, Angina, Arrhythmia, Congestive Heart Failure, and Peripheral Vascular Disease
5 Mind-Body Interventions
5.1 Transcendental Meditation
5.2 Yoga, Mindfulness-Based Stress Reduction (MBSR), and Tai Chi
5.3 Biofeedback Therapy
5.4 Acupuncture
6 Role of Chelation Therapy, Environmental Exposures
7 Resources and Continuing Medical Education
8 Integrative Cardiology Clinical Program Components
9 Conclusion
References
Preventive Cardiology as Specialized Medical Art
1 Introduction
2 The Roots of Prevention
3 Structure, Personnel, and Organization of a Preventive Cardiology Center in the Academic Setting
4 Core Competencies
5 Referrals to Preventive Cardiology Programs
6 Training and Certification
7 Conclusions
References
Index