Cardiovascular disease: strategies for risk assessment and modification.
Cardiovascular disease is the leading cause of death among men and women in the United States. Silent myocardial ischemia, defined as documentation of ischemia in the absence of angina or anginal equivalents, affects up to 4 million Americans and carries a poor prognosis. The assessment of the presence of subclinical coronary atherosclerosis affords an opportunity to identify patients who may be at risk for coronary artery disease over the long term. In addition to traditional risk factors (such as lipid parameters, diabetes, hypertension, smoking, and age), a variety of novel factors (such as lipoprotein[a], homocysteine, and C-reactive protein) may enhance assessment of risk in specific populations. Risk modification should be aimed at achieving recommended levels of lipids and blood pressure, reducing obesity, facilitating optimal management of diabetes and the metabolic syndrome, and encouraging smoking cessation and physical activity. Clinicians should be knowledgeable regarding the application of national guidelines for the reduction of cardiovascular risk so as to maximize the prospects for both the primary and secondary prevention of coronary artery disease and associated adverse outcomes.
Braun
Lynne T
LT
Preventive Cardiology Center; Associate Professor, College of Nursing, Rush University, Chicago, IL 60612, USA. lynne_t_braun@rush.edu
D000293:Adolescent; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000378:metabolism; D002097:C-Reactive Protein / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000453:epidemiology* / Q000378:metabolism; D002995:Clofibric Acid / Q000627:therapeutic use; D015897:Comorbidity; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology; D050171:Dyslipidemias / Q000188:drug therapy / Q000453:epidemiology; D005260:Female; D006710:Homocysteine / Q000378:metabolism; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D006973:Hypertension / Q000453:epidemiology / Q000628:therapy; D015994:Incidence; D008019:Life Style; D017270:Lipoprotein(a) / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D015995:Prevalence; D011379:Prognosis; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D040242:Risk Reduction Behavior; D012907:Smoking / Q000453:epidemiology; D014481:United States / Q000453:epidemiology
D015415:Biomarkers; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D017270:Lipoprotein(a); D006710:Homocysteine; D002995:Clofibric Acid; D002097:C-Reactive Protein