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Atherosclerosis, arteriosclerosis, and "hardening of the arteries'[1] all refer to a process of thickening of the walls of arteries. They eventually encroach on the inside opening or "lumen" of the artery. After a certain point, flow is limited or cut off completely and symptoms occur.
Lipids are fatty substances in blood which participate in this process but by no means are the only cause. Cholesterol is one kind of lipid and triglycerides are another. LDL and HDL are two of the subfractions of cholesterol, commonly measured as well. The blood levels of these four lipids represent the common "cholesterol risk profile". |
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Problem No.1: Unrecognized Risk |
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Heart disease and stroke are the leading cause of death in this country. Each year some 1.5 million people will have a heart attack and one-third of these will die. 41% of all deaths are due to cardiac and vascular disease.[1] This problem contributes to serious ongoing illness and some 6 million hospitalizations each year.[2]
Certain diseases, behaviors, blood abnormalities and genetic traits represent "Risk Factors" which greatly increase the likelihood of having atherosclerotic coronary heart disease, heart attack and stroke. Among these are a family history of premature heart attack or stroke, tobacco abuse, high blood pressure, left ventricular hypertrophy, diabetes, elevated cholesterol, high homocysteine level and elevated Lipoprotein (a) level. Only a minority of Americans are aware that they have any of these and that their risk is higher but modifiable. |
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Problem No.2: Undertreated Risk |
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An estimated 29% of Americans have an elevated cholesterol sufficient to warrant treatment with dietary modification or medications. [3] Targeted cholesterol reduction is one of the most powerful tools we have to slow down or even reverse atherosclerosis.
Treatment goals for cholesterol reduction have been established for people who already have atherosclerosis and for those at high risk who have yet to develop it. However, few patients ever achieve enough reduction to reach their prescribed goal. Medicines are hard to accept and at times difficult to take. Compliance with dietary changes and exercise regimens can be a problem. Only half of those placed on medicines continue them for one year.[4] 30% of the rest regularly miss doses.
Therefore, the benefits of treatment are never achieved. For anyone to successfully follow such a program, considerable organized support and supervision is required. |
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New blood components and new lipid measurements are emerging as other important risk factors. Like the cholesterol profile, these are genetically determined. If present, they greatly increase the possibility of early vascular disease such as heart attack or stroke.
Homocysteine, Lipoprotein (a), LDL particle density, Apoprotein B level, HDL subclass type are among those genetic factors measured by very specialized blood tests. Fibrinogen is a blood Clotting factor which may predispose to early vascular disease if chronically elevated. C-Reactive Protein and certain antibody titers may indicate chronic inflammation or infection of arteries. |
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Who Needs Advanced Risk Assessment? |
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1. Anyone with atherosclerotic heart or vascular disease beginning before age 60: Angina. heart attack, angioplasty, bypass, carotid disease or other vascular disease.
2. Those with a first degree family member such as a parent or sibling with early heart disease.
3. Those with other important risk factors for atherosclerosis such as diabetes, cigarette smoking or high blood pressure.
4. Those with a known cholesterol or lipid disorder such as low HDL or high LDL. |
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Our Center and the Atherosclerosis Prevention Program |
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The best treatment of atherosclerotic risk disorders requires attention to diet, weight, exercise, medication and use of specific vitamins. Periodic routine blood work must be done by your primary physician and specialty lab tests sent when needed. All of this must be tracked, recorded and correlated with improvement in risk level for each patient. This process is best done when supervised by skilled nurses with advanced training in cardiology and risk factor management. Studies have demonstrated that nurse supervised programs have a much higher success rate. [6]
Our Atherosclerosis Prevention Program is supervised by a Nurse Practitioner. Her job is to know each patient well and facilitate all aspects of preventive care. Risk reduction goals are individualized and stated clearly. With attention to detail, record keeping by computer, coordination with your primary physician, blood tests at appropriate times, and telephone contact, the increased genetic risk can be reduced.
Information and education about your specific problem and what you can do about it yourself are the most powerful tools in reducing your risk. We provide educational materials, dietary advice and exercise prescription in addition to genetic risk factor screening. |
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Preventive Cardiology and Your Doctor |
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Your Doctor should be aware of all aspects of your specialty care. Therefore, our Center will communicate with your doctor frequently to coordinate this part of your healthcare program. We will forward copies of all tests we do and obtain copies of blood work and other data from your physician.
Our Preventive Cardiology Center is meant to be an asset to both you and your personal physician. |
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References - Prevention of Atherosclerosis |
1. Singh, GK et al. Annual summary of births, marriages1 divorces and deaths: United States, 1994. Monthly vital statistics report; Volume. 43, number 13. Hyattsville, MD: Public Health Services, 1995.
2. Graves, EJ National Hospital Discharge Survey: Annual summary, 1992. Vital health statistics (13)1994; 119
3. Sempos, CT et al. Prevalence of High Blood Cholesterol among US Adults: An Update Based on Guidelines from the Second Report of the National Cholesterol Education Program Adult Treatment Panel. JAMA 1993; 269: 3009-14.
4. McKenney, JM The Lipid Lowering Formulary. AMJ Managed Care. 1996; 2(Suppl): 548-S53.
5. Insull, W. The Problem of Compliance to Cholesterol Altering Therapy. J Intem MED 1997: 241: 317-325.
6. Becker, OM et al. Nurse Mediated Cholesterol Management Compared with Enhanced Primary Care in Siblings of Individuals with Premature Coronary Disease. Arch Intern Med 1998; 158:1533-1539. |
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