Blumenthal: Preventive Cardiology: Companion to Braunwald's Heart Disease: Expert Consult - Online and Print

For nearly a century, atherosclerotic cardiovascular disease has been the leading cause of death in industrialized countries. It often remains clinically silent for decades before resulting in an acute ischemic syndrome, myocardial infarction, stroke, or sudden cardiac death. Since atherosclerosis is a progressive disease that starts early in life, it challenges us to be more aggressive in our efforts regarding prevention.
Early identification of cardiovascular risk and modification of risk factors reduce the incidence of future cardiovascular events and improve peoples’ quality of life. Unfortunately, rates of obesity and related conditions such as metabolic syndrome and diabetes are on the rise, in both developed and developing countries. Instead of prevention, significant health care dollars are spent on the end-stage complications of atherosclerotic vascular disease, such as drug-eluting stents, implantable cardioverter-defibrillators, and surgical revascularization.
Physicians, nurses, and other health care providers need to emphasize preventive strategies to slow or halt the progression of atherosclerosis. Health care providers need to understand how to optimize cardiovascular risk stratification. The Framingham and other global risk algorithms serve as an important starting point in risk assessment, but have limitations and often exclude key risk factors such as a family history of premature cardiovascular disease, glucose intolerance, triglycerides, waist size, and lifestyle habits. For example, although an adult with a glucose level of 126 mg/dL or higher is automatically placed into a very high risk category, a similar individual with a slightly lower glucose level but who may have additional risk factors or evidence of advanced subclinical atherosclerosis for their age may actually be at higher risk, but would not necessarily qualify for aspirin therapy, antihypertensive therapy, or lipid-lowering therapy.
A great need also exists for better understanding of the significance, clinical utility, and cost-effectiveness of more novel risk factors and screening for asymptomatic cardiovascular disease. Atherosclerosis imaging and measurement of biomarkers such as hs-CRP are now fairly widely performed, and there is a need for understanding how to incorporate into clinical practice the findings from large-scale epidemiologic studies (e.g., Cardiovascular Health Study and the Multi-Ethnic Study of Atherosclerosis) and clinical trials such as JUPITER. However, there are clear limitations to the data that we have so far on biomarkers such as hs-CRP and increasingly popular multimarker approaches, and imaging measures such as coronary artery calcium and carotid intima-media thickness. Experts are clearly split on how to incorporate emerging risk factors and subclinical disease into clinical practice.
The medical community needs to promote guideline adherence and reduce the gap in use of proven medical and lifestyle therapies. Moreover, federal, state, and local governments, education departments and schools, and the corporate sector need to play a greater role in ensuring environments conducive to promoting heart health. The cornerstone of prevention is based on therapeutic lifestyle changes, including regular brisk physical activity and a healthy diet, and strategies to better support these measures need to be developed and implemented at the health care and community level.
In this companion to Braunwald's Heart Disease, we approach cardiovascular disease prevention in a convenient ABCDE framework. In 2002 the AHA and ACC produced a guideline statement on the management of patients with chronic stable angina and arranged their recommendations into an ABCDE format. This approach has also been used as the basis for the training of fellows in preventive cardiology.[1] It has also been used in several evidence based reviews on primary and secondary prevention of CVD, management of non–ST-segment elevation myocardial infarction (NSTEMI) and management of metabolic syndrome.[2-4]
Prevention needs to be a central feature of a sustainable health care system, but implementation of preventive practices remains suboptimal. The ABCDE approach arranges prevention guidelines into an easy-to-remember framework that can be used by clinicians with each patient to ensure comprehensive care. The principal sections of this textbook include: (A) assessment of risk from a clinical and genetic perspective, atherothrombosis and antiplatelet therapy; (B) blood pressure management; (C) cholesterol and dyslipidemia; (D) diet and lifestyle issues (diabetes mellitus ,metabolic syndrome; disparities in care; diagnostic testing to help improve risk prediction); and (E) exercise prescriptions, cardiac rehabilitation and emotional aspects of preventive cardiology.
This text is meant to serve as a guide for those interested in prevention of cardiovascular disease. It provides an overview of the epidemiology and risk factors for cardiovascular disease, and the importance of risk stratification. It underscores the evidence base for the management of cardiovascular risk factors and provides recommendations for clinical care. It our hope that armed with the tools provided in this text we may achieve the promise of the prevention of most cardiovascular disease events in our lifetimes.
Roger S. Blumenthal, JoAnne Foody, Nathan D. Wong

In the middle of the twentieth century, the development of an acute myocardial infarction was often totally unexpected and like the proverbial “bolt out of the blue.” Frequently, apparently healthy persons were struck down during their most productive years, and at a time of large family responsibilities. These “heart attacks” often were either fatal or disabling. Medical attention was focused largely on the diagnosis and management of these catastrophic events. Forestalling or even better, preventing, myocardial infarction was rarely considered.One notable exception, however, was Dr. Paul D. White, often called the “father of American cardiology.” As early as the 1930s, White always included a section on prevention in his lectures on coronary artery disease, and he wrote about it in his famed textbook. The National Heart Institute (now the Heart, Lung and Blood Institute) was established in 1948 and was instrumental in furthering the concept of cardiac disease prevention. Two of the most important early actions by the Institute were the establishment of the Framingham Heart Study and of the Lipid Research Clinics. The former was (and continues to be) a long-term prospective study, with standardized examinations at intervals of adults who were initially without clinical manifestations of coronary artery disease. By 1961, it was evident that overtly healthy subjects with hypertension, hypercholesterolemia, and/or who were cigarette smokers were at higher risk to develop acute myocardial infarction than were their age- and sex-matched controls without these characteristics. Framingham investigators thus coined the term “coronary risk factors.” These observations led to the important idea that the amelioration of risk factors would prevent, or at least delay, the development of clinical coronary artery disease. Considerable research has been done during the past half century that has supported this idea.The institute's second major contribution was the Coronary Primary Prevention trial, which demonstrated that in subjects with hypercholesterolemia, but without overt coronary artery disease, the occurrence of coronary events could be reduced with a diet and cholestyramine, a resin that reduces elevated serum cholesterol. This confirmed, once and for all, the important role of cholesterol in atherogenesis. A breakthrough in coronary prevention occurred in the 1980s with the development of HMGCoA reductase inhibitors (statins), which caused a substantial lowering of LDL-cholesterol. Simultaneously, well tolerated blood pressure-reducing drugs and smoking cessation programs were developed.At first, many cardiologists reacted sluggishly to these observations and often did not incorporate preventive measures into their practices. Both the glamour (and reimbursement) favored the diagnosis and management of acute illness over the more mundane (and poorly reimbursed) efforts required to maintain patients—particularly those who had no overt cardiovascular disease—on diet and other lifestyle measures as well as drugs, which often have some annoying side effects. However, during the 1990s, the evidence in favor of the clinical benefits of prevention became overwhelming, and in the first decade of this century, expert committees developed practice guidelines that provided strong support. Adherence to these guidelines became important measures of physician performance, a trend that only promises to increase in coming years.Now, in the second decade of the current century, preventive cardiology has a robust and rapidly growing knowledge base. In addition to hypercholesterolemia, hypertension and cigarette smoking described a half century ago, we now recognize that diabetes, vascular inflammation, kidney disease, passive smoking, and a growing number of biomarkers and genetic variants may also be used in refining assessment of coronary risk.Preventive Cardiology is very capably edited by Drs. Blumenthal, Foody, and Wong, and written by stellar authors, all experts in their subjects. It is a superb, well written and illustrated volume that elegantly weaves together the many separate strands of this critically important area of cardiology to provide a thorough understanding of the field. This volume should serve the needs of a broad audience. Prevention of cardiovascular disease is too important to leave to a relatively small group of experts, but instead must be carried out by all physicians, regardless of specialty, as well as by nurses and other health care professionals who care for patients with, or at risk of developing, cardiovascular disease. All of these groups and their trainees can profit enormously from this important book.We are therefore very pleased to welcome Preventive Cardiology to the growing list of Companions to Heart Disease.
Eugene Braunwald, Robert Bonow, Douglas Mann, Douglas Zipes, Peter Libby 

Key Features
  • Recognize the factors for prevention and risk stratification around cardiovascular disease and effectively delay the onset of disease and moderate the effects and complications, even for individuals who are genetically predisposed.
  • Effectively navigate full range of considerations in prevention from epidemiology of heart disease, biology of atherosclerosis and myocardial infraction, risk assessment-established risk factors and emerging risk factors, multiple risk factor-based prevention strategies, and future directions-through genetics, personalized medicine, and much more.
  • Gain a deeper understanding of the pathogenesis of disease and the rationale for management through discussions of basic science.
  • Apply current clinical practice guidelines to ensure optimal outcomes in both primary and secondary prevention.

Website Features
  • Consult the book from any computer at home, in your office, or at any practice location.
  • Instantly locate the answers to your clinical questions via a simple search query.
  • Quickly find out more about any bibliographical citation by linking to its MEDLINE abstract.

Section I - Assessment of Risk
CHAPTER 1 - Preventive Cardiology: Past, Present, and Future
CHAPTER 2 - National and International Trends in Cardiovascular Disease: Incidence and Risk Factors
CHAPTER 3 - Prediction of Cardiovascular Disease: Framingham Risk Estimation and Beyond
CHAPTER 4 - Genetics of Cardiovascular Disease and Its Role in Risk Prediction
CHAPTER 5 - Novel Biomarkers and the Assessment of Cardiovascular Risk
CHAPTER 6 - Advanced Risk Assessment in Patients with Kidney and Inflammatory Diseases

Section II - Atherothrombosis and Antiplatelet Therapy
CHAPTER 7 - Antiplatelet Therapy
CHAPTER 8 - Molecular Biology and Genetics of Atherosclerosis

Section III - Blood Pressure
CHAPTER 9 - Hypertension: JNC 7 and Beyond
CHAPTER 10 - Heart Failure Prevention
CHAPTER 11 - Antihypertensive Drugs and Their Cardioprotective and Renoprotective Roles in the Prevention and Management of Cardiovascular Disease

Section IV - Cholesterol/ Dyslipidemia
CHAPTER 12 - Evaluation and Management of Dyslipidemia in Children and Adolescents
CHAPTER 13 - The Role of High-Density Lipoprotein Cholesterol in the Development of Atherosclerotic Cardiovascular Disease
CHAPTER 14 - Low-Density Lipoprotein Cholesterol: Role in Atherosclerosis and Approaches to Therapeutic Management
CHAPTER 15 - The Contribution of Triglycerides and Triglyceride-Rich Lipoproteins to Atherosclerotic Cardiovascular Disease

Section V - Diet and Lifestyle Factors
CHAPTER 16 - Nutritional Approaches for Cardiovascular Disease Prevention
CHAPTER 17 - Integrative Medicine in the Prevention of Cardiovascular Disease
CHAPTER 18 - Effects of Alcohol on Cardiovascular Disease Risk
CHAPTER 19 - Overweight, Obesity, and Cardiovascular Risk
CHAPTER 20 - Tobacco Use, Passive Smoking, and Cardiovascular Disease: Research and Smoking Cessation Interventions

Section VI - Diabetes Mellitus
CHAPTER 21 - Diabetes and Cardiovascular Disease
CHAPTER 22 - Metabolic Syndrome and Cardiovascular Disease

Section VII - Special Populations
CHAPTER 23 - Role of Ethnicity in Cardiovascular Disease: Lessons Learned from MESA and Other Population-Based Studies
CHAPTER 24 - Prevention of Ischemic Heart Disease in Women
CHAPTER 25 - Cardiovascular Aging: The Next Frontier in Cardiovascular Prevention

Section VIII - Diagnostic Testing to Help Improve Risk Prediction
CHAPTER 26 - Concepts of Screening for Cardiovascular Risk Factors and Disease
CHAPTER 27 - Role of Vascular Computed Tomography in Evaluation and Prevention of Cardiovascular Disease
CHAPTER 28 - Use of Cardiac Magnetic Resonance Imaging and Positron Emission Tomography in Assessment of Cardiovascular Disease Risk and Atherosclerosis Progression
CHAPTER 29 - Exercise Treadmill Stress Testing With and Without Imaging
CHAPTER 30 - Carotid Intima-Media Thickness Measurement and Plaque Detection for Cardiovascular Disease Risk Prediction
CHAPTER 31 - Peripheral Arterial Disease Assessment and Management
CHAPTER 32 - Endothelial Function and Dysfunction

Section IX - Exercise/Emotional Aspects of Preventive Cardiology
CHAPTER 33 - Exercise for Restoring Health and Preventing Vascular Disease
CHAPTER 34 - Psychological Risk Factors and Coronary Artery Disease: Epidemiology, Pathophysiology, and Management
CHAPTER 35 - The Role of Treatment Adherence in Cardiac Risk Factor Modification
CHAPTER 36 - Clinical Practice Guidelines and Performance Measures in the Treatment of Cardiovascular Disease

Product Details 

  • Hardcover: 632 pages
  • Publisher: Saunders; 1 Har/Psc edition (February 25, 2011)
  • Language: English
  • ISBN-10: 1437713661
  • ISBN-13: 978-1437713664
  • Product Dimensions: 11.1 x 8.9 x 1.1 inches 
List Price: $159.00 

Look for These Other Titles in the Braunwald's Heart Disease Family  
Braunwald's Heart Disease Companions Series
Or go to Braunwald's Heart Disease 9th Edition 

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