Cardiovascular disease (CVD) remains the number one cause of mortality for both men and women in the United States1. Although CVD related mortality is decreasing with advanced diagnostic testing and therapies of CVD, the prevalence of this disease remains high including in the younger aged population younger than 55 years of age1. This suggests that as providers we have done a successful job at treating CVD however there remains a lot of work to be done with regards to preventing this disease.
Moving the Needle
The prevention of CVD disease requires effort not just at the individual provider- patient level, but requires effort at the professional organization/societal and legislative level. The focus of the recent 2018 American Heart Association Scientific Meeting on several areas of Preventive Cardiology such as the recently released 2018 Cholesterol Practice Guidelines as well as the recently released Department of Health and Human Services Physical Activity Guidelines for Americans indicates that there is some momentum and interest in moving the focus of health care from solely treating CVD to also preventing CVD in addition to treatment. The 2018 Cholesterol management guideline document has indicated that assessment of CVD risk begins as early as 20-39 years of age and this provides an opportunity to counsel these patients on heart healthy lifestyle modification to improve their cholesterol profile and therefore decrease their CVD risk2. The cholesterol guidelines also focus on the fact that the lower the cholesterol level the lower the CVD risk2.
It has been shown that most individuals in the United States do not report enough physical activity to meet the American Heart Association physical activity guidelines1. The recently released Department of Health and Human Services Physical Activity Guidelines for Americans also indicates that there is also legislative support for increasing physical activity in an effort to improve the cardiovascular health of Americans3.
The Million Hearts 2022 national initiative that is co-led by the Centers for Disease Control and Prevention and the Centers for Medicare & Medicaid Services is also another effort in the prevention of CVD. The goal of this initiative is to prevent 1 million heart attacks and strokes in 5 years through focused partner actions on several priorities selected for their impact on heart disease, stroke, and related conditions.
These initiatives indicate that there is an effort to move the needle of healthcare to preventative medicine. This plays an important role in decreasing CVD prevalence and will therefore lead to improved CVD outcomes for the United States population.
Impact on our Patients
A heart healthy diet and a physically active lifestyle has been shown to decrease the risk of developing CVD disease1. Counselling patients on a heart healthy lifestyle positively impacts our patients as it raises their awareness of the impact of lifestyle on overall cardiovascular health and also encourages them to adopt a heart healthy lifestyle.
More Work to be Done
Adequate training in Preventive Cardiology for fellows has been lacking as many of our trainees are not being taught the required amount of preventive cardiology during their General Cardiology fellowship training4. A survey in 2012 indicated that only a quarter of the surveyed General Cardiology fellowship training programs met the Core Cardiology Training Symposium (COCATS) guidelines recommendation of a dedicated 1 month rotation in preventive cardiology. In view of this, many Cardiologists in practice do not include nutritional and physical activity assessment as a part of their clinical evaluation. As a result, counselling on a heart healthy lifestyle as a part of preventive cardiology is not practiced by many Cardiologists. This void in training and experience in preventive cardiology provides an opportunity for us to assess and improve our own practice in this area as Cardiologists and also provides an opportunity to develop formal training in Preventive Cardiology for our cardiology fellows.
Despite the fact that CVD disease related mortality is decreasing in the United States, the prevalence remains high1. This indicates that providers within the Cardiovascular community have done a great job in treating CVD disease but there is still a need to improve our practice with regards to preventing CVD. The movement by the American Heart Association, Centers for Disease Control and Prevention and the Centers for Medicare & Medicaid Services in focusing on areas of lifestyle medicine and preventive cardiology indicates that there is an effort to shift the needle from not just treating CVD disease but also preventing this disease. This movement therefore provides an opportunity for the Cardiovascular community to improve our practice in this area and to equip our cardiology fellows with adequate training in Preventive Cardiology to become better practitioners in this area in their future role as Cardiologists.
- Benjamin EJ, Virani SS, Callaway CW, sChamberlain AM, Chang AR, et al. Heart Disease and Stroke Statistics—2018 Update: A Report From the American Heart Association
- Grundy SM, Stone NJ, Bailey AL, Beam LT, Birtcher KK, et al. 2018AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol. JACC Nov 2018, 25709; DOI: 10.1016/j.jacc.2018.11.003
- The Physical Activity Guidelines for Americans: THe HHS Roadmap for an Active Healthy Nation. Second Edition. ADM Brett P. Giroir, MD
- Pack QR,Keteyian SJ, McBride PE, Weaver WD, Kim HE. Current status of preventive cardiology training among United States cardiology fellowships and comparison to training guidelines. Am J Cardiol 2012;110:124-8.