Currently Viewing:
European Society of Cardiology (ESC) 2017
Currently Reading
Dr Christi Deaton on the Most Important Steps for Cardiovascular Prevention
November 12, 2017
Dr Jeanette Stingone on Environmental Factors That Impact Public Health
November 07, 2017
Christi Deaton: Challenges of Motivating Patients to Participate in CVD Prevention Strategies
November 04, 2017
Dr John Rumsfeld on the Digital Transformation of Cardiovascular Medicine
October 24, 2017
Dr Deepak Bhatt on the Impact of the COMPASS Trial on Standard of Care
October 19, 2017
Dr Jeanette Stingone: Air Pollution Is an Issue Everywhere in the US
October 12, 2017
Dr John Rumsfeld Outlines ACC's Main Goals for the Future of Cardiology
October 07, 2017
Dr Simon Gibbs Discusses the Future of Pulmonary Hypertension Treatments
October 03, 2017
Dr Steven Nissen Argues for Aggressively Lowering LDL Cholesterol
October 01, 2017
Dr John Eikelboom on the COMPASS Trial Findings
September 28, 2017
Dr John Eikelboom on the Surprising Results of the COMPASS Trial
September 15, 2017
Dr Simon Gibbs Outlines Monotherapy vs Combination Therapy in Pulmonary Hypertension
September 14, 2017
Dr Christi Deaton: Ask Cardiac Patients About Their Diet and Exercise
September 12, 2017
Dr Steven Nissen on Which Patients Should Be Treated With PCSK9 Inhibitors
September 11, 2017
Dr Jeanette Stingone on Lasting Cardiovascular Effects of Prenatal Exposure to Air Pollution
September 07, 2017
Dr Christi Deaton on Promoting Better Self-Management for Patients With CVD
August 29, 2017
Dr John Eikelboom: COMPASS' Rivaroxaban Plus Aspirin Will Become Standard for CAD, PAD
August 29, 2017
Comorbidities in Patients With Heart Failure: Treating the Whole Patient
August 29, 2017
Dr Simon Gibbs on Daily Management of Patients With Pulmonary Hypertension
August 28, 2017

An Eye on Cardiovascular Prevention: Begin in Childhood, Identify All Risk Factors

Laura Joszt
For each level of cardiovascular risk, lifestyle factors remain a significant contributor that can be modified to reduce risk. However, some risk will remain nonmodifiable and require therapy, according to panelists during a session on cardiovascular prevention at the European Society of Cardiology Congress 2017, held August 26-30 in Barcelona, Spain.
For each level of cardiovascular risk, lifestyle factors remain a significant contributor that can be modified to reduce risk. However, some risk will remain nonmodifiable and require therapy, according to panelists during a session on cardiovascular prevention at the European Society of Cardiology Congress 2017, held August 26-30 in Barcelona, Spain.

Ulrich Laufs, MD, of the University of Leipzig, led the session with an approach to treat young patients with multiple risk factors. Images of human coronary arteries have shown that atherosclerosis can start as early as 7 years old, Laufs explained.

Cardiovascular disease (CVD) remains a main killer for people with atherosclerosis, but a significant part of the risk is preventable through early detection, healthy lifestyle, and therapies. Addressing the modifiable aspects requires an early detection of risk factors and then the implementation of a healthy lifestyle, but “for specific patients, there will be additional drug treatments needed,” Laufs said.

He highlighted that lowering low-density lipoprotein (LDL) cholesterol with statins leads to approximately a 25% risk reduction per year. However, it is important to understand that the effects are not as potent during the first year—the treatment takes some time to start working.

There are challenges to this long-term type of therapy. Studies have shown that when it comes to medication adherence for statins, only one-third of statins are taken as intended over the long term.

“We need therapies that are easier and advance adherence,” Laufs said.

One therapy under investigation is small interfering RNA, which only requires a few doses per year to lower LDL. Another is a vaccination. Patients can be immunized and see their LDL dramatically lowered. Vaccination is only currently being tested in animals and would not be available for humans until much further down the road.

Christos Lionis, MD, PhD, of the University of Crete, followed up with a presentation on how mental health factors into cardiovascular risk. While depression and anxiety can increase CVD risk, he noted that primary care physicians and cardiologists are not always prepared or able to recognize mental health disorders or frailty in the elderly.

For patients who are identified as having mental illness, they should be considered priority patients, Lionis said. It’s important to note that psychotropics used to treat patients with mental illness increase the risk of sudden death and ventricular fibrillation. Suggested interventions for these patients include exercise, mindful meditation, breathing exercises, medications, and cognitive behavioral therapy.

To facilitate changes in behavior, Lionis discussed motivational interviewing, which can be used to strengthen a patient’s commitment to change. This is a conversation style intervention that can help motivate patients to change behavior that increases CVD risk, such as to stop smoking.

“We need to always be thinking of mental health playing a role in … cardiovascular disease,” he said. “And it starts not in adulthood, but in childhood. Always think about the behavioral change technique, which does not need many hours,” to be successful.

Having comorbidities along with CVD is not unusual, explained Pavel Svitil, MUDr, during his portion of the presentation. He presented a number of cases from his practice to explain why he always keeps in mind 2 words when caring for patients using the guidelines: “however” and “nevertheless.”

There are always modified or calculated risks to keep in mind, such as family history, psychosocial risk factors, cancer treatment, and presence of autoimmune diseases.

In one example, Svitil presented the case of a 52-year-old male who was a nonsmoker, not obese, had no diabetes, experienced some stress at work, and was physically active. His blood pressure was normal, his cholesterol almost normal, and he had no symptoms of coronary artery disease (CAD). However, this man had a family history to keep in mind: his father had diabetes and hypertension and his first acute myocardial infarction when he was 50 years old, and the patient’s 2 brothers had hypertension.

The patient was treated for grade 1 hypertension, hypercholesterolemia, and dyslipidemia, and told to have an annual cardiologic follow-up. From 2012 to 2016, the patient saw improvements in hypertension and cholesterol. However, in 2017 his health started to worsen and he was diagnosed with multivessel CAD. So the patient had a percutaneous coronary intervention.

The point of this case, and the others Svitil presented, was to remind attendees that other factors may mean veering from guidelines.

In the case of the 52-year-old male, Svitil said, “an asymptomatic and low-risk patient with family history can become a high-risk patient.”

 
Copyright AJMC 2006-2017 Clinical Care Targeted Communications Group, LLC. All Rights Reserved.
x
Welcome the the new and improved AJMC.com, the premier managed market network. Tell us about yourself so that we can serve you better.
Sign Up
×

Sign In

Not a member? Sign up now!