cardiovascular disorders
Overview of Coronary Artery Disease
Prevention of Coronary Artery Disease
The American Heart Association (AHA) recommends using the pooled cohort risk assessment equations to estimate lifetime and 10-year risk of atherosclerotic cardiovascular disease. The risk calculator is based on sex, age, race, total and high-density lipoprotein (HDL) cholesterol levels, systolic blood pressure (and whether blood pressure is being treated), diabetes, and smoking status ( Prevention references ). Prevention of coronary artery disease involves Treatment : Smoking Cessation None Weight loss Healthful diet Regular exercise Modification of serum lipid levels Reduction of salt intake Control of hypertension Control of diabetes vary. In the US, for patients who are at low risk (< 10% 10-yearrisk) of atherosclerotic cardiovascular disease (ASCVD), antihypertensives are recommended if blood pressure is > 140/90. In patients with coronary artery disease or whose risk of ASCVD is > 10%, antihypertensive treatment is recommended for blood pressure > 130/80 mm Hg ( Prevention references ). Modification of serum lipid levels(particularly with statins) may slow or even partially reverse the progression of CAD. Treatment goals have been modified. Instead of trying to achieve specific target low density lipoprotein cholesterol (LDL) levels, patients are selected for treatment based on their risk of ASCVD. Lower risk patients with elevated LDL may not require statin treatment. Four higher risk patient groups have been identified in whom the benefit of statin therapy outweighs the risk of adverse events: Patients with clinical ASCVD Patients with LDL cholesterol ≥ 190 mg/dL (≥ 4.9 mmol/L) Patients age 40 to 75 years with diabetes and LDL cholesterol levels of 70 to 189 mg/dL (1.8 to 4.9 mmol/L) Patients age 40 to 75 years without diabetes and LDL cholesterol levels of 70 to 189 mg/dL (1.8 to 4.9 mmol/L) with ASCVD risk > 7.5% 1.03 mmol/L), although several trials have failed to demonstrate a lower risk of ischemia or slowed progression of atherosclerosis when drugs are used to raise HDL ( Prevention references ). Aspirinis not recommended for primary prevention of CAD in patients ≥ 60 years. It can be considered for patients aged 40 to 59 whose 10-year risk of cardiovascular disease exceeds 10%, but absolute benefit is likely to be small. 1.Arnett DK, Blumenthal RS, Albert MA, et al: 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.J Am Coll Cardiol74:1376–1414, 2019. 2.Whelton PB, Carey RM, Aronow WS, et al: ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.J Am Coll Cardiol71:e127–e248, 2018. 3.AIM-HIGH Investigators, Boden WE, Probstfield JL, Anderson T, et al:Niacinin patients with low HDL cholesterol levels receiving intensive statin therapy.N Engl J Med365(24): 2255–2267, 2011. doi: 10.1056/NEJMoa1107579 