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CME: Updated Guidelines for Assessing Cardiovascular Risk

CME: Updated Guidelines for Assessing Cardiovascular Risk

Cardiovascular disease (CVD) caused by atherosclerosis continues to be the leading cause of death and is a major cause of disability as well as a significant source of healthcare costs in the United States. In 2013, the American College of Cardiology (ACC) and the American Heart Association (AHA) released an updated clinical practice guideline to help clinicians better identify adults who may be at high risk for developing atherosclerotic CVD. The update, published jointly in the Journal of the American College of Cardiology and Circulation, also provides recommendations for identifying patients who could benefit from lifestyle changes or drug therapy to help prevent CVD. “These guidelines were last updated about 10 years ago,” says David C. Goff, Jr., MD, PhD, who co-chaired the ACC/AHA risk assessment guideline writing group. “Since that time, we have collected a large amount of research that has further enhanced our understanding of how best to care for these patients and improve our approaches to determining who should get specific types of preventive treatments.” Risk Assessment A key goal of the ACC/AHA guideline is to ensure that preventive treatments—especially lifestyle changes and drug treatment—are used in those who are most likely to benefit from them. To do this, the guideline includes high-quality risk assessment methods that use risk factors that are known to lead to atherosclerosis (Table 1). Factors such as age, cholesterol levels, blood pressure, smoking, and diabetes can be easily collected by clinicians and then integrated into a risk score to guide care and prompt discussions with patients.   “The vast majority of heart attacks and strokes could be prevented if patients knew...
Updated Guidelines for Assessing Cardiovascular Risk

Updated Guidelines for Assessing Cardiovascular Risk

Cardiovascular disease (CVD) caused by atherosclerosis continues to be the leading cause of death and is a major cause of disability as well as a significant source of healthcare costs in the United States. In 2013, the American College of Cardiology (ACC) and the American Heart Association (AHA) released an updated clinical practice guideline to help clinicians better identify adults who may be at high risk for developing atherosclerotic CVD. The update, published jointly in the Journal of the American College of Cardiology and Circulation, also provides recommendations for identifying patients who could benefit from lifestyle changes or drug therapy to help prevent CVD. “These guidelines were last updated about 10 years ago,” says David C. Goff, Jr., MD, PhD, who co-chaired the ACC/AHA risk assessment guideline writing group. “Since that time, we have collected a large amount of research that has further enhanced our understanding of how best to care for these patients and improve our approaches to determining who should get specific types of preventive treatments.” Risk Assessment A key goal of the ACC/AHA guideline is to ensure that preventive treatments—especially lifestyle changes and drug treatment—are used in those who are most likely to benefit from them. To do this, the guideline includes high-quality risk assessment methods that use risk factors that are known to lead to atherosclerosis (Table 1). Factors such as age, cholesterol levels, blood pressure, smoking, and diabetes can be easily collected by clinicians and then integrated into a risk score to guide care and prompt discussions with patients.   “The vast majority of heart attacks and strokes could be prevented if patients knew...

Conference Highlights: ASE 2012

New research was presented at ASE 2012, the American Society of Echocardiography’s 23rd Annual Scientific Sessions, from June 30 to July 3 in Maryland. The features below highlight just some of the studies that emerged from the conference. Echocardiograms for Diagnosing Pulmonary Hypertension The Particulars: Patients with stable heart failure who have high pulmonary artery systolic pressure are at increased risk for adverse outcomes. A reliable method is needed for measuring pulmonary artery systolic pressure in this patient population. Data Breakdown: Emory University researchers used echocardiography to diagnose pulmonary hypertension— defined as pulmonary artery systolic pressure higher than 45 mm Hg—in stable outpatients with heart failure. Echocardiography was found to strongly predict higher risk of clinical events. The testing also helped determine which patients would have higher hospitalization rates. Take Home Pearl: Pulmonary artery systolic pressure as measured by echocardiography appears to provide important prognostic information for patients with stable heart failure. Ultrasonography Helps Predict Atherosclerosis The Particulars: The incidence of peripheral arterial disease is rising throughout the United States. However, data from large population-based samples on the prevalence of subclinical atherosclerosis in the peripheral arteries are lacking. Data Breakdown: Investigators in a study used ultrasound exams to look for the presence and degree of popliteal arterial plaque as a predictor of atherosclerosis. Popliteal artery atherosclerosis was prevalent among patients aged 40 or younger who were at risk for becoming obese and/ or having diabetes. Popliteal artery atherosclerosis was independently associated with older age and albuminuria. Urinary albuminuria was also linked with the severity of atherosclerotic plaque burden in the popliteal arteries. Take Home Pearl: Among younger patients with...

Self-Expanding Stent System Approved

The FDA has approved a self-expanding peripheral stent system (EverFlex, ev3) for use in re-opening stenotic regions in the superficial femoral and proximal popliteal arteries. The stent system is designed to restore blood flow to the legs of patients with atherosclerosis. Source:...

Reducing the Burden of Peripheral Arterial Disease

Peripheral arterial disease (PAD) affects an estimated 8 to 10 million Americans, a number that is expected to increase as the population ages and as diabetes and obesity become more prevalent. Clinical research has shown that PAD is associated with a high risk of major cardiovascular events. While PAD shares risk factors of those associated with heart attack and stroke, it doesn’t always have a dramatic onset. Even in cases where PAD disease onset is severe, it’s often not treated as seriously as it should be. New Study Data In the November 2010 issue of Circulation: Cardiovascular Quality & Outcomes, my colleagues and I used data from the REduction of Atherothrombosis for Continued Health (REACH) Registry to assess hospitalization rates and costs in patients with PAD. The registry included individuals who were at risk of atherothrombosis caused by established arterial disease or the presence of three or more atherothrombotic risk factors. The societal cost associated with the consequences of PAD is enormous. Prior research from our group estimated the costs associated with vascular-related hospitalizations alone in patients with PAD to be $21 billion in the United States. Roughly half of those costs are associated with PAD-specific treatment, while the other half relates to other cardiovascular-related hospitalizations, such as for heart attack and stroke.  Invasive treatment for PAD is costly, and a first invasive procedure becomes a risk factor for further procedures. We are dealing with both clinically and economically severe consequences of a truly preventable disease in PAD. In this latest study, we looked at the 2-year rates of vascular-related hospitalizations and associated costs in U.S. patients with established PAD...
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