Considering Cost Effectiveness in Cardiovascular Risk Reduction - Episode 5
Dr Ann Marie Navar highlights a variety of strategies, including lifestyle modifications, that can be useful when managing dyslipidemia to reduce cardiovascular risk.
Deepak L. Bhatt, MD, MPH: Let’s move on to a discussion treatment of dyslipidemia. Everyone is pretty much in agreement that that is a central approach to reducing the risk of cardiovascular disease, that LDL [low-density lipoprotein]—lowering therapies are an important part. Fortunately, there are several effective, safe ways of doing that. But before diving into details, I’d just like to ask Dr Navar what some of the ways are to reduce cardiovascular risk more globally, focusing on things like weight, blood pressure, diabetes, and of course dyslipidemia. In your own practice you take a very holistic approach. What are your recommendations for our audience on strategies to help modify risk in this multipronged approach?
Ann Marie Navar, MD, PhD: We often talk about therapies, but the most important thing for everybody to reduce cardiovascular risk is lifestyle. A heart-healthy diet, avoiding excess sugar and excess calories, and maintaining a healthy weight are critical, as is exercise. Five days a week, 30 minutes a day cardiac exercise is probably the more important of things that our patients can do in addition to not smoking to lower their risk of heart disease.
We know of some other things from long studies that are critically important; for example, controlling blood pressure. A lot of patients with hypertension remain uncontrolled. We have a lot of therapies available, and almost everybody with hypertension can get to goal. It just takes some work.
Diabetes is increasing in prevalence in the United States as the obesity epidemic increases the rate of metabolic syndrome and diabetes. Although glycemic control has shown a dramatic improvement in microvascular outcomes, we need to think beyond hemoglobin A1C [glycated hemoglobin] for our patients with diabetes when we’re trying to prevent cardiovascular events. The ADA [American Diabetes Association] guidelines actually recommend that for those with cardiovascular disease, we need to be using medications like GLP1 receptor agonists and SGLT2 inhibitors, which have independent effects to lower cardiovascular risks beyond their impact on glycemic control. We’ll talk about dyslipidemia next, but it’s important that we don’t forget there are lots of other ways to lower risk.
The final piece of this, as you, Dr Bhatt, have contributed substantially to in literature, is thinking about preventing thrombotic complications. The use of aspirin in high-risk patients for primary prevention and then selecting the appropriate antiplatelet—and in some cases anticoagulant—therapy for patients with established cardiovascular disease can also help reduce thrombotic complications of the atherosclerotic disease that patients have.