Treating to protect: current cardiovascular treatment approaches and remaining needs.
Current best practice to reduce cardiovascular disease involves evaluating patients' global cardiovascular risk profiles and devising treatment strategies accordingly. Despite the proven efficacy of this approach, very few physicians are adequately assessing risk, and consequently patients are failing to achieve desired treatment targets. Modifying lifestyle factors, such as diet, exercise, and cessation of smoking, remains one of the simplest and most potent means of reducing risk. Newly emerging evidence suggests that moderate physical activity (such as brisk walking for 30 minutes a day), eg, by raising levels of circulating endothelial progenitor cells, improves endothelial function and enhances vascular repair. However, patients remain remarkably reluctant to lifestyle changes, even in the face of overt, life-threatening disease. Statin treatment reduces cardiovascular morbidity and death in both primary and secondary prevention studies. However, over 90% of adults at high risk for coronary heart disease fail to achieve target low-density lipoprotein cholesterol levels in spite of statin therapy. Similarly, only about 37% of patients with hypertension meet blood pressure targets. Antihypertensive drugs achieve different levels of cardioprotection. Mounting evidence links regimens containing beta-blockers or diuretics with higher incidence of type 2 diabetes. In contrast, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers appear to confer extra protection on target organs on top of blood pressure reduction. The ONTARGET Trial Program is designed to clarify the importance of this effect. Educating patients, raising physicians' awareness, and implementing effective and safe treatment regimens are all necessary steps to bring about the much-needed improvements in cardiac health outcomes.
Böhm
Michael
M
Department of Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine, Saarland University Hospital, Homburg/Saar, Germany. michael.boehm@uniklinikum-saarland.de
Werner
Christian
C
Jakobsen
Anne
A
Heroys
Jose
J
Ralph
Ann
A
Rees
Tomas
T
Shaw
Michael
M
D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D006801:Humans; D011322:Primary Prevention / Q000639:trends*; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D040242:Risk Reduction Behavior
D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D002316:Cardiotonic Agents