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Published on: September 26, 2018
Cardiovascular Disease Prevention: Prevention Through Control of Medical Risks
Brian V Reamy1, Anthony J Viera2
1Department of Family Medicine - Uniformed Services University School of the Health Sciences School of Medicine, 4301 Jones Bridge Rd, Bethesda, MD 20814.
Insights
Controlling diabetes, hypertension, smoking, and obesity is crucial for preventing cardiovascular disease (CVD). Individualized treatment goals balance risk reduction with potential adverse effects for better patient outcomes.
Area of Science:
- Cardiology
- Endocrinology
- Public Health
Background:
- Cardiovascular disease (CVD) risk is significantly increased by diabetes, hypertension, tobacco use, and obesity.
- Effective CVD prevention requires diligent management of these risk factors.
- Social determinants of health play a primary role in disparities in CVD outcomes across racial and ethnic groups.
Purpose of the Study:
- To outline current recommendations for managing key risk factors for cardiovascular disease.
- To emphasize the importance of individualized treatment goals in CVD prevention.
- To highlight the most effective interventions for smoking cessation and obesity management.
Main Methods:
- Review of guidelines from organizations like the American Diabetes Association (ADA).
- Analysis of evidence supporting specific A1c and blood pressure (BP) targets.
- Evaluation of pharmacotherapy and surgical interventions for smoking cessation and weight management.
Main Results:
- ADA recommends an A1c goal of <7% for most adults with diabetes, balancing efficacy with hypoglycemia risk.
- A BP goal of <140/90 mm Hg is advised for adults, with individualized targets considering benefits and risks.
- Varenicline combined with nicotine replacement therapy is highly effective for smoking cessation; bariatric surgery is optimal for obesity management.
Conclusions:
- Optimizing management of diabetes, hypertension, smoking, and obesity is essential for cardiovascular disease prevention.
- Individualized treatment targets for A1c and BP are necessary to maximize benefits and minimize risks.
- Addressing social determinants of health is critical for reducing CVD outcome disparities.
Abstract:
Diabetes, hypertension, tobacco use, and obesity each substantially increases the risk of cardiovascular disease (CVD) and must be controlled as part of CVD prevention. Among patients with diabetes, the reduction of CVD risk from lower A1c goals must be balanced against the risks of hypoglycemia. The American Diabetes Association (ADA) recommends an A1c goal for adults of less than 7% if hypoglycemia can be avoided. A less stringent goal of less than 8% is appropriate in patients with limited life expectancy. A blood pressure (BP) goal of less than 140/90 mm Hg is prudent for all adults younger than 60 years. A goal of less than 140/90 mm Hg also is advised for initiating or intensifying pharmacotherapy in adults 60 years and older with a history of stroke or who are at high cardiovascular risk. BP targets should be individualized to balance the known benefits of lowering BP to 120/80 mm Hg with the risks of morbidity because of hypotension and adverse effects. Varenicline is the most effective drug for smoking cessation, and abstinence rates are increased by combining it with nicotine replacement therapy. Bariatric surgery is the most effective management for long-term weight loss and reduction of obesity-related comorbidities. Social drivers of health are the primary cause of CVD outcomes differences among races and ethnicities.
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