Primary And Secondary Prevention Of Ascvd Pdf
File Name: primary and secondary prevention of ascvd .zip
- CVD Prevention in Clinical Practice (European Guidelines on) Guidelines
- Secondary Prevention of Cardiovascular Diseases and Application of Technology for Early Diagnosis
- Statins and LDL-C in Secondary Prevention—So Much Progress, So Far to Go
Aim is to discuss the presentation, modifying factors, and treatment decisions of hypercholesterolemia usually with statins in older persons and focusing on primary prevention. Available data do not imply specific harms in older patients, and, therefore, also, judicious primary prevention is possible. All these, as well as personal preferences, must be taken into account in treatment decisions. Like all prevention, statin treatment should be discontinued when palliative treatment is started. Because prevention requires a certain amount of life expectancy to be relevant, it is important to realize that the mean life expectancy for an year-old woman is between 7.
CVD Prevention in Clinical Practice (European Guidelines on) Guidelines
Cardiovascular diseases result in millions of deaths around the globe annually, most of which are avoidable if identified early. Preventive healthcare has a major role in the fight against cardiovascular diseases.
Primary, secondary, and tertiary prevention have their own applications along with benefits and drawbacks. Secondly, it analyzes different risk factors associated with cardiovascular diseases and then discusses incoming technological trends in cardiovascular disease prediction and finally provides an insight into the importance of secondary prevention of cardiovascular diseases and commonly prescribed interventions for high risk patients. Health and wellbeing is one of the most primary and significant concerns for mankind.
However this concern is constantly challenged by diseases and illnesses. While some of these diseases are fatal, some can be cured or their negative impacts could be minimized if diagnosed at early stages. The diseases that challenge the wellbeing of an organism can be categorized into two main categories based on the agent of the said disease. Diseases that are spread by infectious agents such as viruses and bacteria are referred to as communicable diseases while other diseases that are not caused by infectious diseases are known as noncommunicable diseases NCD that are caused by a combination of genetic, physiological, environmental, and behavioral factors.
Cardiovascular diseases cause an average of Cardiovascular diseases CVD are a group of disorders of the heart and blood vessels which is the most significant cause of death globally.
CVD has both health and social impacts. Long term treatments for cardiovascular diseases demand significant financial resources. This could cause poverty in low and middle income families. Widespread of CVD may ultimately cause a burden on the economies of the country [ 3 ].
In countries where medical and healthcare sector is not advanced, diagnosis of CVD could be late, which would result in patient conditions irreversibly worsen or even death. This could reduce the life expectancy levels in the country. There are three types of prevention mechanisms to prevent and reduce the impacts of a disease. Primary prevention refers to the steps taken by an individual to prevent the onset of the disease.
This is achieved by maintaining a healthy lifestyle choice such as diet and exercise. Secondary prevention focuses on reducing the impact of the disease by early diagnosis prior to any critical and permanent damage.
This facilitates avoiding life threatening situations and long term impairments from a disease. Tertiary prevention is used once long term effects set in, by helping the patients to manage pain, increase life expectancy, and increase the quality of life.
The secondary prevention of CVD includes diagnosis and prevention. Most critical step of secondary prevention is early diagnosis which allows medical professionals to provide required care for patients and improve the quality of life. This requires identifying risk factors, criticality of risk factors, and how the variation of these factors relates to CVD. Upon early diagnosis, patients could be directed to required treatments affording a higher quality of life.
Main attraction of secondary prevention over tertiary prevention comes from two factors. Factor one is the cost where the cost of secondary prevention is far less relative to tertiary prevention.
Secondly it effects on the quality of life of the patient. Tertiary prevention involves major procedures that could cause discomfort to the patient as well as disrupt the daily activities, whereas secondary prevention focuses on less intense treatments which include drugs and lifestyle changes. Therefore creating awareness on secondary prevention could create positive impacts on individual lives as well as on a macroeconomic level.
Cardiovascular diseases refer to all illnesses associated with heart and circulatory system. These illnesses are sometimes caused by modifiable risk factors such as diet, exercise, and other lifestyle choices while on certain occasions they are caused by unmodifiable factors such as age, gender, family history, and genetic predisposition for the disease [ 6 ]. These cardiovascular diseases have long lasting effects if not treated properly and are considered to be one of the most significant causes of death all around globe.
Most common types of CVD include coronary artery diseases CAD , cerebrovascular disease, peripheral arterial disease, and congenital heart disease. CAD, the most common type of CVD, refers to the condition where circulatory vessels that supply oxygenated blood to the heart get narrowed. This occurs due to a deposition of plaque a combination of cholesterol, macrophage cells, calcium, and fibrous connective tissue inside coronary arteries.
This condition is referred to as atherosclerosis [ 7 ]. Once these plaques rupture, blood clots are formed inside the arteries which could lead to the partial or complete blockage of blood supply to the heart muscles.
Symptoms of CAD include dyspnea shortness of breath , myocardial infarction, and angina pectoris. Out of the above-mentioned symptoms, myocardial infarction and angina pectoris are frequently interchanged.
Angina pectoris is a state in which the blood supply to the myocardium is significantly reduced thereby creating a squeezing or burning sensation at the sternum.
However, myocardium necrosis has not yet occurred at this stage. In contrast, myocardial infarction which is commonly known as a heart attack is a state where, due to the unavailability of oxygenated blood, death of myocardial cells occurs. Both of these conditions can be identified using an electrocardiogram ECG where myocardial infarction presents with a ST segment flat section of the ECG between the end of the S wave and the beginning of the T wave depression or elevation and T wave inversion and angina pectoris present with only ST segment inversion.
Research has identified several risk factors associated with CAD including cholesterol, smoking, obesity, and blood pressure [ 4 , 8 ]. Apart from the above, diabetes mellitus commonly referred to as diabetes has a strong relationship with CAD. Studies have revealed that hyperglycemia accelerates the process of atherosclerosis by creating biochemical changes in the human body [ 9 ]. Out of those variables, research has identified that cholesterol and blood pressure contribute more towards CAD.
In the case of blood pressure, it has been found out that stage 1 hypertension creates a higher risk for CAD [ 10 ]. Cerebrovascular disease is a type of CVD associated with circulatory vessels that supply blood to the brain, causing the patient to have a stroke. The most common cause of cerebrovascular disease is hypertension which causes the artery inner lining to damage. This damage results in aggregation if there are platelets in the area where collagen is exposed.
Four most common types of cerebrovascular diseases are stroke, transient ischemic attack TIA , subarachnoid hemorrhage, and vascular dementia. Stroke occurs by a blockage of oxygenated blood to the brain due to thrombosis or embolism, which would lead to brain damage [ 11 ].
There exist three main types of causes for cardioembolic strokes, namely, arrhythmia, valve disorders, and cardiac chamber and wall abnormalities. Out of these causes atrial fibrillation type of arrhythmia is considered a major etiology of strokes [ 12 ].
Atrial fibrillation is a condition where the atrium fibrillates instead of fully contracting there by creating an irregular heartbeat.
This fibrillation causes blood to pool allowing the formation of clots. These clots could block arteries that supply blood to the brain resulting in a stroke. TIA is a type of stroke that occurs temporarily with symptoms similar to a stroke.
Subarachnoid hemorrhage is caused by blood leaking onto the surface of the brain or out of the arteries [ 13 ].
This leaked blood results in damaging brain tissue and neural structures. Along with hypertension obesity, diabetes and smoking have been identified as the most leading causes for cerebrovascular diseases.
Congenital heart diseases are associated with the structure of the heart. This condition is most commonly identified as birth defects, in the newborn children. Defects may vary such as structural defects of heart walls, heart valves, or even veins and arteries around the heart which could result in blocking blood flow, forcing the blood to flow in the wrong direction, and slowing down the blood flow.
Symptoms of CHD are mostly identified at birth, but in certain cases patients may go undiagnosed for a long time or even their entire life. Common symptoms of CHD are heart murmur, underdeveloped limbs, and shortness of breath, fatigue, and cyanosis. Causes for congenital heart diseases may not be directly identifiable. They could be caused by different factors such as infections during pregnancy rubella , use of certain drugs, alcohol, and tobacco, genetic predisposition, or even poor nutrition.
Treatment for CHD may depend on the severity of the defect. While in certain cases, treatment is not required, some might demand heart surgery in order to repair the defects or even heart transplants. A condition caused by reduced blood supply to limbs due to atherosclerosis fatty deposits in arteries is referred to as peripheral arterial disease PAD. This is commonly associated with legs.
Common symptoms of PAD include discoloration of legs, cramps in hip and calf muscles, and hair loss on limbs. However in many instances, these symptoms may go unnoticed. Most common risk factors of PAD include high blood pressure, smoking, diabetes, high blood lipids, and high levels of homocysteine. Out of these, smoking and diabetes have the biggest contribution to PAD as they reduce the blood flow to the limbs.
Peripheral arterial disease could lead to further complications such as critical limb ischemia where the open sores occur in limbs that are irrecoverable. These sores may cause tissue death in the limb which could ultimately lead to the amputation of the limb. Cardiovascular diseases may be caused as a result of many risk factors. These factors can be generally categorized into two groups, namely, modifiable risk factors and nonmodifiable risk factors.
Modifiable risk factors refer to controllable causes of cardiovascular disease such as obesity, blood lipids, and behavioral factors. Nonmodifiable risk factors are those which cannot be controlled such as age, gender, and genetic predisposition. Awareness of these risk factors is highly critical in both stages of secondary prevention, early diagnosis, and treatment. Understanding risk factors and their interactions allow medical professionals to understand whether or not a particular individual is at risk and if so, how they could be controlled.
This section provides an insight into few risk factors for CVD and their effect. CVD is one of the most leading causes of death for people in both genders.
However, statistical analysis shows that certain manifestations of CVD are more common in one gender relative to the other. It has been established that males are more prone to coronary heart diseases [ 14 ] while women have a higher risk of being subjected to strokes and heart failures [ 15 ]. A study conducted in Netherlands with participants has identified that the risk of CVD for men and women around the age of 55 is relatively similar. The estimated lifetime risk of CVD for men was However, this research has found out that there are significant differences in the first manifestations of CVD in men and women.
According to the research document, The general low susceptibility of women to cardiovascular diseases as evident by Figure 1 can be attributed to cardioprotective effects of estrogen. Furthermore, it is said that estrogen inhibits the development and progression of atherosclerosis. However, with menopause, due to reduction of estrogen, the susceptibility of women to CVD increases to approximately the same level as of men.
Secondary Prevention of Cardiovascular Diseases and Application of Technology for Early Diagnosis
Statins and other cholesterol-lowering drugs are increasingly being used for the primary prevention of atherosclerotic cardiovascular disease. In the micrograph image, cholesterol crystals. Statins lower serum cholesterol carried by atherogenic lipoproteins  , such as low-density lipoprotein cholesterol LDL-C and very-low-density lipoprotein cholesterol VLDL-C , which together constitute non-high-density lipoprotein cholesterol non-HDL-C. Many randomised controlled trials RCTs show that statins effectively lower atherogenic cholesterol levels and reduce risk for atherosclerotic cardiovascular disease ASCVD. Some investigators speculate that statins have benefits beyond cholesterol lowering; pleiotropic effects that remain to be proved. On account of its high efficacy, statin therapy is virtually mandatory for most patients with established ASCVD secondary prevention ,  but for the population as a whole, the greatest potential benefit lies in prevention of ASCVD in the first place primary prevention. Statin use in primary prevention is the subject of great debate.
Elevated circulating concentrations of low-density lipoproteins have been definitively demonstrated to be a cause of atherosclerotic cardiovascular disease ASCVD. The largest absolute benefits of statin therapy occur in individuals at the greatest risk, such as those who have already experienced an ASCVD event. However, Yao and colleagues 3 shed light on how and why this is not the case in an actual setting. Their year retrospective cohort study using administrative data from in the US demonstrated increases in the proportion of secondary prevention patients receiving statins The proportion of patients adherent to statin therapy also increased, from It is clear that these trends are all in the right direction, but there is still a very long way to go to obtain the maximum possible health benefits from lipid-lowering therapy. Of particular concern was the finding by Yao and colleagues 3 that women and ethnic minorities were less likely to receive and adhere to statins.
To develop clinical practice guidelines for the primary prevention of atherosclerotic cardiovascular disease ASCVD and type 2 diabetes mellitus T2DM in individuals at metabolic risk for developing these conditions. Health care providers should incorporate regular screening and identification of individuals at metabolic risk at higher risk for ASCVD and T2DM with measurement of blood pressure, waist circumference, fasting lipid profile, and blood glucose. Individuals identified at metabolic risk should undergo year global risk assessment for ASCVD or coronary heart disease to determine targets of therapy for reduction of apolipoprotein B—containing lipoproteins. Hypertension should be treated to targets outlined in this guideline. Individuals with prediabetes should be tested at least annually for progression to diabetes and referred to intensive diet and physical activity behavioral counseling programs. Behavioral programs should include a heart-healthy dietary pattern and sodium restriction, as well as an active lifestyle with daily walking, limited sedentary time, and a structured program of physical activity, if appropriate. Behavior changes should be supported by a comprehensive program led by trained interventionists and reinforced by primary care providers.
Statins and LDL-C in Secondary Prevention—So Much Progress, So Far to Go
Elevated circulating concentrations of low-density lipoproteins have been definitively demonstrated to be a cause of atherosclerotic cardiovascular disease ASCVD. The largest absolute benefits of statin therapy occur in individuals at the greatest risk, such as those who have already experienced an ASCVD event. However, Yao and colleagues 3 shed light on how and why this is not the case in an actual setting.
- Я являюсь заместителем оперативного директора агентства. - Усталая улыбка промелькнула на его лице. - И потом, я не. Рядом со мной Сьюзан Флетчер. В тот момент Сьюзан поняла, за что уважает Тревора Стратмора.
Он вытер их о брюки и попробовал. На этот раз створки двери чуть-чуть разошлись. Сьюзан, увидев, что дело пошло, попыталась помочь Стратмору. Дверь приоткрылась на несколько сантиметров. Они держали ее что было сил, но сопротивление оказалось чересчур сильным и створки снова сомкнулись. - Подождите, - сказала Сьюзан, меняя позицию и придвигаясь ближе. - Хорошо, теперь давайте.
В этот субботний вечер в Коридоре красного дерева было пусто, все служащие давно разошлись по домам, чтобы предаться излюбленным развлечениям влиятельных людей. Хотя Бринкерхофф всегда мечтал о настоящей карьере в агентстве, он вынужден был довольствоваться положением личного помощника - бюрократическим тупиком, в который его загнала политическая крысиная возня. Тот факт, что он работал рядом с самым влиятельным человеком во всем американском разведывательном сообществе, служил ему малым утешением. Он с отличием окончил теологическую школу Андовери колледж Уильямса и, дожив до средних лет, не получил никакой власти, не достиг никакого значимого рубежа. Все свои дни он посвящал организации распорядка чужой жизни. В положении личного помощника директора имелись и определенные преимущества: роскошный кабинет в директорских апартаментах, свободный доступ в любой отдел АН Б и ощущение собственной исключительности, объяснявшееся обществом, среди которого ему приходилось вращаться. Выполняя поручения людей из высшего эшелона власти, Бринкерхофф в глубине души знал, что он - прирожденный личный помощник: достаточно сообразительный, чтобы все правильно записать, достаточно импозантный, чтобы устраивать пресс-конференции, и достаточно ленивый, чтобы не стремиться к большему.
Беккер безучастно кивнул: - Так мне сказали. Лейтенант вздохнул и сочувственно помотал головой.
Сьюзан поняла, в чем дело: все это время Хейл вел себя тихо, подозрительно тихо, поскольку отлично знал, что нет такой диагностики, в которой использовалась бы цепная мутация, тем более такая, которая занимала ТРАНСТЕКСТ уже восемнадцать часов. Хейл не проронил ни слова. Казалось, вспыхнувшая на его глазах перепалка абсолютно его не касается. Очевидно, Стратмор вдруг задумался:. У Сьюзан имелся на это ответ.
Вскоре она едва заметно кивнула и широко улыбнулась. - Дэвид, ты превзошел самого. Люди на подиуме с недоумением переглянулись.
Беккер не сразу почувствовал, что его кто-то подталкивает. Подняв глаза, он увидел старика с усыпанным родинками лицом, который стоял перед ним, намереваясь пройти. Беккера охватила паника. Он уже хочет уйти.