Comprehensive Management of High Risk Cardiovascular Patients

by Gotto, Jr.; Antonio M.

• ISBN13: 9780849340666
• ISBN10: 0849340667
• Edition: 1st
• Format: Hardcover
• Copyright: 2006-10-11
• Publisher: CRC Press

Summary

Cardiovascular disease, including heart disease, peripheral arterial disease, and stroke, is the leading cause of illness and death in the United States. Filling a gap in the literature, this reference contains expert contributions on the care and management of patients at high-risk for cardiovascular disease and studies early indicators and risk factors that may impact therapeutic treatment, as well as aid in the early detection of heart conditions.

Table of Contents

Series Introduction	v
Samuel Z. Goldhaber
Preface	vii
Acknowledgments	ix
Contributors	xvii
Risk Factors for Cardiovascular Disease and the Framingham Study Equation	1	(18)
William B. Kannel
Peter W. F. Wilson
Key Points	1	(1)
Introduction	1	(1)
Lifetime Risks	2	(1)
Multivariable Risk Assessment	2	(3)
Risk Factors	5	(3)
Hypertension	8	(3)
Diabetes	11	(1)
Dyslipidemia	12	(1)
Preventive Management Based on Risk Assessment	13	(1)
Conclusions	14	(1)
References	15	(4)
Arterial Hypertension	19	(44)
Daniel A. Duprez
Daniel J. Wilson
Key Points	19	(1)
Introduction	20	(1)
Definition	20	(1)
Epidemiology of Hypertension	20	(2)
Mechanisms of Hypertension	22	(4)
Etiology of Hypertension	26	(8)
Complicated Management Problems in Hypertension	34	(2)
Blood Pressure Measurement	36	(4)
Evaluation of Hypertension	40	(1)
Treatment	41	(7)
Guidelines for Treatment of Hypertension	48	(5)
Recent Landmark Hypertension Trials: Implications for Evidence-Based Medicine	53	(1)
Valsartan Antihypertensive Long-Term Use Evaluation (VALUE) Trial	54	(1)
Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT)	55	(1)
Conduit Artery Function Evaluation (CAFE) Trial	55	(1)
Trial of Prevention of Hypertension (TROPHY)	55	(1)
References	56	(7)
Obesity and Lifestyle Modification	63	(16)
Herman Blomeier
Neil J. Stone
Key Points	63	(1)
Introduction	63	(1)
Measuring Overweight, Obesity, and Body Fat	63	(3)
Magnitude of the Problem	66	(1)
A Brief Review of Weight Loss Physiology	67	(1)
Clinical Disorders Related to Obesity	67	(1)
Management of the Obese Patient	68	(1)
Evaluation of Patients	68	(1)
Initiating Discussions About Management with Patients	69	(1)
Diet as Part of Lifestyle Therapy	70	(4)
Behavioral Approaches	74	(1)
Integrating Behavioral Approach into Lifestyle Change	75	(1)
Conclusions	75	(1)
References	76	(3)
Effects of Nutrient Supplements and Nutraceuticals on Risk for Cardiovascular Disease	79	(68)
Yumei Cao
Jun Zhang
Penny M. Kris-Etherton
Key Points	79	(1)
Introduction	79	(1)
Antioxidant Vitamins	80	(11)
B Vitamins	91	(3)
Minerals	94	(5)
Fish Oil Supplementation	99	(14)
Botanical Agents	113	(5)
Other Nutrition Supplements and CVD Risk	118	(7)
Drug-Herb Interactions	125	(1)
Supplements Recommended for CVD Risk Reduction	126	(2)
Summary	128	(3)
Resources	131	(1)
References	131	(16)
Type 1 Diabetes Mellitus	147	(40)
David W. Gardner
Khurshid A. Khan
Gurushankar Govindarajan
John M. Palmer
James R. Sowers
Key Points	147	(1)
Epidemiology and Prevalence	147	(1)
Pathogenesis of Type 1 Diabetes Mellitus	148	(1)
Nonmajor Histocompatibility Genes	149	(2)
Diagnostic Criteria for Type 1 Diabetes Mellitus	151	(2)
Type 1 Diabetes Mellitus and Cardiovascular Disease	153	(3)
Goals of Therapy	156	(17)
Diabetic Ketoacidosis	173	(5)
References	178	(9)
Type 2 Diabetes	187	(68)
Ronald Goldberg
Key Points	187	(1)
Introduction	188	(1)
Epidemiology of Cardiovascular Disease in Type 2 Diabetes	189	(3)
Etiopathogenesis of Cardiovascular Disease in Diabetes	192	(14)
Evaluation and Management of CVD Risk Factors	206	(32)
Conclusion	238	(1)
References	239	(16)
Management of Elevated Low-Density Lipoprotein Cholesterol	255	(40)
Michael H. Davidson
Jennifer G. Robinson
Key Points	255	(1)
Low-Density Lipoprotein as a Cardiovascular Risk Factor	255	(5)
Critical Role of LDL-C in Atherogenesis	260	(2)
National Cholesterol Education Program Adult Treatment Panel III Goals for LDL-C	262	(1)
Calculating the Global Risk Score	263	(4)
Metabolism of LDL-C	267	(1)
Genetic Causes of Elevated LDL-C	268	(2)
Secondary Causes of Elevated LDL-C	270	(1)
Nonpharmacological Therapy	270	(2)
Pharmacological Therapy	272	(12)
Difficult-to-Treat Patients	284	(3)
References	287	(8)
High-Density Lipoprotein Cholesterol	295	(46)
Peter P. Toth
Antonio M. Gotto, Jr.
Key Points	295	(1)
Introduction	296	(1)
Epidemiology	296	(3)
Antiatherogenic Effects of High-Density Lipoprotein	299	(9)
Pharmacologic Management of Low High-Density Lipoprotein Cholesterol	308	(6)
The Effects of Lifestyle Factors on High-Density Lipoprotein Cholesterol	314	(1)
Cigarette Smoking	315	(1)
Diet	316	(7)
Emerging Therapies	323	(3)
References	326	(15)
Triglycerides and Risk for Atherosclerotic Disease	341	(48)
Gerald Luc
Patrick Duriez
Jean-Charles Fruchart
Key Points	341	(1)
Introduction	341	(1)
Hypertriglyceridemia and Cardiovascular Risk	341	(1)
Non-High-Density Lipoprotein Cholesterol as a Risk Factor	342	(1)
Etiology and Pathophysiology	342	(23)
Effects of Hypolipidemic Drugs on Serum Triglycerides	365	(4)
Clinical Trials	369	(6)
Evaluation and Management in a Hypertriglyceridemic Patient	375	(6)
References	381	(8)
Safety of Dyslipidemic Agents	389	(20)
Stefano Bellosta
Rodolfo Paoletti
Alberto Corsini
Key Points	389	(1)
Introduction	389	(1)
Statins	389	(2)
Liver Transaminase Elevations	391	(1)
Myopathy	392	(1)
Rhabdomyolysis	392	(2)
Effect of Statins on Coenzyme Q10 Levels	394	(1)
Proteinuria	394	(1)
Neuropathy	394	(1)
High-Dose Statin Therapy	394	(1)
Statin Interactions with Cytochrome P450 Inhibitors	395	(2)
Statins and Calcium Antagonists	397	(1)
Statin Interactions with Cytochrome P450 Inducers	397	(1)
Interactions Between Statins and Fibric Acid Derivatives	397	(1)
Other Statin Interactions	397	(2)
Fibrates	399	(1)
Combination Fibrates-Statins	400	(1)
Ezetimibe	401	(1)
Bile Acid Sequestrants	402	(1)
Nicotinic Acid (Niacin)	403	(1)
Conclusions	404	(1)
References	404	(5)
The Metabolic Syndrome: Identification and Management of the Patient at High Risk for Cardiovascular Disease	409	(32)
Charles Reasner
Key Points	409	(1)
Definition	409	(1)
Prevalence	410	(2)
Pathogenesis	412	(3)
Cellular Mechanisms of Insulin Resistance	415	(2)
Insulin Signal Transduction Defects in Insulin Resistance	417	(1)
Clinical Manifestations of the Metabolic Syndrome	418	(1)
Atherogenic Dyslipidemia	418	(1)
Elevated Triglyceride Levels	418	(1)
Low Levels of High-Density Lipoprotein Cholesterol	419	(1)
Small, Dense Low-Density Lipoprotein Particles	419	(1)
Associated Risk Factors	419	(1)
Lipid Goals for Patients with the Metabolic Syndrome	419	(1)
Pharmacologic Therapy	420	(1)
Statins	420	(2)
Combination Therapy	422	(1)
Fibrates	422	(3)
Niacin	425	(1)
Physical Activity and Fitness in the Primary Prevention of Diabetes	426	(1)
Cardiorespiratory Fitness and the Development of Diabetes	427	(1)
Pharmacologic Interventions for Diabetes Prevention	428	(1)
Cardiovascular Disease in Polycystic Ovary Syndrome	429	(1)
Pharmacologic Treatment of PCOS	430	(1)
References	431	(10)
Inflammatory Mediators and C-Reactive Protein	441	(22)
John A. Farmer
Key Points	441	(1)
Introduction	441	(1)
The Use of Inflammatory Markers in the Prediction of Cardiovascular Risk	442	(1)
Mechanisms of Inflammation in the Pathogenesis of Atherosclerosis	442	(5)
Inflammation and the Classical Risk Factors	447	(3)
Interventions That Modify CRP	450	(5)
Other Emerging Markers of Inflammation	455	(1)
Clinical Recommendations	456	(1)
Conclusions	457	(1)
References	457	(6)
Chronic Kidney Disease	463	(38)
Nelson Kopyt
Key Points	463	(1)
Case	463	(1)
Chronic Kidney Disease: What Is the Crisis?	463	(3)
Definition of Chronic Kidney Disease	466	(2)
Is Chronic Kidney Disease Associated with Increased Cardiovascular Disease Risk?	468	(3)
Cardiorenal Syndrome	471	(2)
Relationship Between CKD and CVD Risk	473	(1)
Metabolic Syndrome and Chronic Kidney Disease	474	(2)
Proteinuria: A Risk Factor for Chronic Kidney Disease and Cardiovascular Disease	476	(3)
Approach to CKD: Need for Coordinated Management to Reduce CVD Risk	479	(3)
Anemia: A CKD-Related Nontraditional CVD Risk Factor	482	(2)
Cardiovascular Calcification in CKD	484	(5)
Role of Angiotensin II Modulating Therapy in CKD/CVD	489	(2)
Summary	491	(1)
References	492	(9)
Anticoagulation and Antiplatelet Agents	501	(24)
Adnan K. Chhatriwalla
Deepak L. Bhatt
Key Points	501	(1)
Overview	502	(1)
Pathogenesis of Thrombosis	502	(2)
Acute Coronary Syndrome	504	(4)
Percutaneous Coronary Intervention	508	(3)
Primary and Secondary Prevention of MI	511	(3)
Atrial Fibrillation and Atrial Flutter	514	(2)
Dilated Cardiomyopathy	516	(1)
Deep Venous Thrombosis and Pulmonary Embolism	516	(2)
Peripheral Arterial Disease	518	(1)
Future Directions	519	(1)
References	519	(6)
Congestive Heart Failure: Epidemiology, Pathophysiology, and Current Therapies	525	(20)
Nicolas W. Shammas
Key Points	525	(1)
Epidemiology of CHF	525	(1)
Pathophysiology of CHF	525	(1)
ACC/AHA Classification of CHF	526	(1)
Pharmacologic Therapy of CHF	527	(10)
Conclusion	537	(1)
References	538	(7)
Stroke Prevention	545	(40)
Shyam Prabhakaran
Bernardo Liberato
Ralph L. Sacco
Key Points	545	(1)
Introduction	545	(1)
Overview of Ischemic Stroke	545	(2)
Epidemiology of Stroke	547	(1)
Risk Factors for Ischemic Stroke	547	(15)
Secondary Prevention of Stroke	562	(6)
Other Putative Stroke Risk Factors	568	(3)
Conclusions	571	(2)
References	573	(12)
Peripheral Arterial Disease	585	(26)
Stanley G. Rockson
Emil M. deGoma
Key Points	585	(1)
Introduction	585	(1)
Epidemiology	585	(1)
Prognostic Significance	586	(1)
Pathophysiology	587	(1)
Clinical Manifestations	587	(2)
Clinical Classification	589	(1)
Diagnostic Evaluation	589	(3)
Management of Atherothrombotic Disease	592	(6)
Management of Intermittent Claudication	598	(5)
Summary	603	(1)
References	604	(7)
Acute Myocardial Infarction	611	(36)
James T. Willerson
Paul W. Armstrong
Key Points	611	(1)
Pathophysiology	611	(1)
Acute Myocardial Infarction	611	(3)
Clinical Detection of Myocardial Infarction	614	(1)
Physical Examination	615
Myocardial Stunning and Hibernation	516	(101)
Serologic Tests for Myocardial Infarction	617	(1)
Prognosis	617	(1)
Evaluation of Ventricular Function	618	(1)
Biomarkers	618	(3)
Treatment	621	(1)
Specific Therapies: Evidence Based	622	(3)
Platelet Glycoprotein IIb/IIIa Receptor Antagonists	625	(1)
Clopidogrel	625	(1)
Platelet Glycoprotein IIb/IIIa Receptors	626	(1)
Platelet Glycoprotein IIb/IIIa Receptor Antagonists	626	(4)
Conservative Versus Interventional Therapy	630	(1)
Angiotensin Converting Enzyme Inhibitors	631	(4)
Initial Therapy of Stemi	635	(1)
Other Considerations	636	(3)
Summary	639	(1)
References	639	(8)
Tobacco and Cardiovascular Disease	647	(42)
Robyn L. Richmond
Nicholas Zwar
Rowena Ivers
Key Points	647	(1)
Introduction	648	(1)
Prevalence of Smoking Rates	648	(16)
Public Health Approaches to Reducing Tobacco Use	664	(4)
Treating Tobacco Dependence	668	(13)
Conclusion	681	(1)
References	682	(7)
Women and Coronary Heart Disease	689	(32)
Vera Bittner
Key Points	689	(1)
Epidemiology of Coronary Heart Disease in Women	689	(1)
Pathology, Pathophysiology, and Symptoms	689	(3)
Diagnosis	692	(1)
Risk Factors Leading to the Development of CHD	693	(12)
Assessment of Risk	705	(2)
Prevention Guidelines	707	(4)
Conclusions	711	(1)
References	711	(10)
Cardiovascular Disease in Racial and Ethnic Minorities	721	(32)
Keith C. Ferdinand
Annemarie Armani
Key Points	721	(1)
Introduction	721	(1)
Epidemiology of Race	722	(2)
Cardiovascular Morbidity and Mortality in Racial/Ethnic Groups	724	(5)
Asian or Pacific Islanders and CVD	729	(1)
Disease Characteristics and Risk Factors	730	(7)
C-Reactive Protein	737	(1)
Risk Factor Clustering	737	(1)
Risk Assessments	738	(1)
Racial Disparity in Health Care	738	(1)
Procedures	739	(1)
Hospitals	739	(2)
Racial Variations in Drug Use	741	(1)
Therapeutic Goals	741	(1)
Under-Representation in Clinical Trials	742	(1)
Barriers	742	(1)
Cultural Barriers	743	(1)
Health Care Providers	744	(1)
References	745	(8)
Index	753