Introduction
Preventive cardiology takes measures to prevent CVD, reduce the burden, and improve the quality of life and life expectancy in individuals with CVD. In doing so, preventive cardiologists help prevent invasive cardiovascular procedures, including heart bypass surgery and cardiac stenting. Unfortunately, CVD is the leading cause of death for both men and women in America. About one in every four deaths in the US can be attributed to heart disease. In addition, advanced CVD can often lead to a heart attack or stroke.
What Is Preventive Cardiology?
Preventive cardiology refers to a specialty detecting CVDs in their earliest stages, along with their effective treatments. In the clinical context, it focuses explicitly on the followings;
-
Individuals with confirmed atherosclerotic disease.
-
Individuals with a subclinical status of CVD.
-
Individuals have a high multifactorial risk of the development of CVD.
This subspeciality aims to encourage the prevention of CVD, advocate for the protection of cardiovascular health, and share high-quality, evidence-based knowledge through the education of healthcare personnel and their patients.
What Are the Types of Cardiac Prevention?
-
Primary Prevention: The field of preventive cardiology has developed to treat the spectrum of cardiac disease risk factors and coronary artery disease via the assessment of individual risk and prompt initiation of interventions to stop, delay, or modify the development of clinical atherosclerosis.
-
Secondary Prevention: It treats individuals after the embodiment of symptomatic coronary artery disease and CVDs.
Which Specialties Does the Preventive Cardiology Team Include?
Cardiologists are not the only constituents of a preventive cardiology team. Preventive cardiology also comprises other disciplines, offering the best management when a dedicated team provides longitudinal care.
Preventive cardiology involves an interdisciplinary approach and aims to include the followings;
-
Internal medicine.
-
Endocrinologists.
-
Family physicians.
-
Obstetricians and gynecologists.
-
Clinical pharmacists.
-
Pediatricians.
-
Clinical psychologists.
-
Clinical geneticists.
-
Nurses.
-
Advanced practice providers.
-
Dietitians.
What Are the Core Competencies of Preventive Cardiology?
Core competencies of a preventive cardiology practice include three major compartments as described below;
1. Cardiovascular Risk Assessment: It uses risk calculators, biochemistries, non-invasive imaging, genetic analyses, and functional testing.
2. Co-morbidity Management: That effectively treats diabetes, obesity, hypertension, gout, systemic inflammatory diseases, dyslipidemia, and more.
3. Lifestyle Management: It includes exercise, using natural supplements to manage chronic conditions, diet, counseling on medicine options, stress reduction, weight management, smoking cessation, and addiction interventions.
What Are the Risk Factors for the Development of CVD?
Many of these risk factors are common, acquired, and adjustable and, therefore, can be used in risk assessment findings for a proper category of affected individuals and to monitor the efficacy of treatment.
Atherosclerotic CVD is a complex, slow-progressing, multi-factorial deterioration of the blood-carrying vessel wall that leads to occlusion either by an obstacle or by superimposed thrombosis. This atherosclerosis is a significant risk factor for coronary heart disease.
Preventive cardiology is a concept central to evaluating, preventing, and treating atherosclerotic CVD. The understanding is that dyslipidemia (abnormal amount of lipids in the blood), smoking, inheritance, hypertension, diabetes, and stress are linked to atherosclerotic CVD. Therefore, this risk factor management and providing preventive services can mitigate the burden of atherosclerotic CVD.
Who Should Consult a Preventive Cardiologist?
Certain medical conditions and lifestyles can increase the risk of CVD. However, unless prevention measures and scale-up management methods for CVD risk factors and co-morbidities are not established, it will continue to control life expectancy.
Ascending evidence demonstrates that effective control of the following is required to decrease the risk of a first or successive heart attack;
-
Hypertension.
-
Increased blood lipid profiles.
-
Heavy smoking.
-
Obesity.
What Are the Measures of Preventive Cardiology?
The foundation of cardiovascular health maintenance includes:
-
Cessation or avoidance of smoking.
-
Careful diet.
-
Regular exercise.
-
Weight management.
-
Stress management.
-
Regular check-ups of cholesterol, blood sugar, and blood pressure.
Statin: Lipid-lowering trials are the most crucial advancement in healthcare of the twentieth century, which declines the risk of a heart attack.
More lipid profile reduction provided more CVD benefits because of the improvements in cardiovascular outcomes monitored in individuals with average or even low blood lipid levels. Statin utilization in practice transformed from treating only clearly elevated lipid profiles to treating all individuals with CVD risk thresholds. As a result, most individuals taking statins do not acquire severe hypercholesterolemia (high cholesterol level in blood), and many have no lipid profile abnormalities.
Today average American has an LDL (low-density lipoprotein) cholesterol of about 110 mg/dl (milligrams per deciliter). Yet, if this individual falls in the high CVD risk categories, then decreasing LDL cholesterol by 10, 40, or up to 55 points is required to achieve optimal levels.
Since guidelines insist so much on aggressive LDL cholesterol management, prescribing statins has become the primary role of a preventive cardiologist.
Glp-1 Ra (Glucagon-Like Peptide-1 Receptor Agonists) And Sglt-2I (Sodium-Glucose Cotransporter-2 Inhibitors): These are a class of medications used in treating type 2 diabetes. Individuals with type 2 diabetes risk developing CVDs, including heart failure, myocardial infarction, stroke, and cardiovascular death. Multiple cardiovascular outcome trials with SGLT2i and GLP-1 RA have demonstrated strong and significant reductions in major adverse cardiovascular events. These interventions have CVD risk reduction power but do not affect lipids.
Icosapent Ethyl: It is a lipid-regulating agent that reduces the blood's triglycerides (fat-like substance) levels. It is also used with statins to reduce the risk of a stroke, heart attack, or other heart problems requiring hospitalization in individuals with high triglyceride levels, heart disease, or type 2 diabetes.
What Are the Services That Preventive Cardiology Provides?
Since most individuals seeking preventive cardiology services are at clear risk of developing a first or recurrent CVD event, the most appropriate strategy for a preventive cardiology practice is prescribing cardiovascular medicine with coordination of additional care such as diagnostic testing, referrals to general cardiology, heart failure, electrophysiology, interventional.
-
The Clinical Pharmacist: Helps improve the safety and efficacy of therapeutic interventions, medication adherence, insurance coverage, and cost control of branded medications.
-
Lifestyle Counseling Services: Experts provide professional and efficient lifestyle counseling services for CVD risk management, such as eating well, managing stress, losing weight, and quitting smoking. CVD is often the result of decades of poor lifestyle choices.
-
An Expert Provider: Manages risk for cardiovascular outcomes besides coronary events and appropriate use of novel drugs for metabolic control, which may impact the risk of any cardiac outcome, such as SGLT-2i, GLP1-RA, and Icosapent ethyl.
-
Other Services: By trained nurses, registered dieticians, and lifestyle coaches for weight control, exercise prescription, and psychological support.
Conclusion
Preventive cardiology demands specialized knowledge of metabolism, anatomy, cardiovascular physiology, functional stress testing, imaging, cardiac rehabilitation, natural therapies, pharmacology, and lifestyle management. Since Ischemic cardiovascular disease continues to be the most common cause of death after 55 years of age everywhere in the world, there is a need for preventive cardiology to prevent the probable CVDs, and this effort requires lifestyle counseling, dietary interventions, pharmacotherapy, the use of natural supplements, and efficient cross-referral strategies.
