ISSN:0889-4655    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Significant advances have been made in both the development and implementation of drug therapy in the primary and secondary prevention of cardiovascular disease. Defining “aggressive” drug therapy mandates consideration of the target population, timing of initiation, time of administration, and, often, dose titration to achieve a desired effect on relevant “biomarkers” such as low-density lipoprotein levels. This review focuses on 2 groups of drug therapies now proven effective in prevention, namely the statins and antiplatelet drugs (aspirin, clopidogrel). Angiotensin-converting enzyme inhibitor(s), angiotensin receptor blockers, and beta blockers are also proven of great value but are only noted in the table.

ISSN:0889-4655    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

In the 1990s a number of randomized controlled trials provided compelling evidence for the importance of aggressively managing hypercholesterolemia. Control of low-density lipoprotein cholesterol reduces cardiac events and stroke in at risk individuals without known cardiac disease and in patients with coronary heart disease. The National Cholesterol Education Program Adult Treatment Panel has published 3 sets of guidelines. The most recent expanded definitions of those at risk by defining new risk categories and increased the numbers of persons who could benefit from more intensive cholesterol-lowering. These new definitions moved millions of people into more intensive treatment categories compared to previously published guidelines. This article focuses on the latest National Cholesterol Education Program guidelines for identification and treatment of persons with or at risk for coronary heart disease.

ISSN:0889-4655    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Obesity has reached epidemic proportions in the United States and in most industrialized nations. More than 60% of US adults are now overweight or obese, predisposing over 97 million Americans to a host of chronic lifestyle diseases, particularly cardiovascular disease. Despite the existence of explicit evidence-based consensus reports on the health risks of obesity and the health benefits of even moderate amounts of weight loss, many patients do not receive advice from their health care providers to lose weight or on how to do so effectively. Even modest physical activity and small incremental healthy dietary changes when incorporated into one's lifestyle have a positive effect on weight loss and promote the maintenance of favorable body weight and body composition changes with advancing age. This article describes elements of effective counseling and practical guidelines for developing a healthy lifestyle approach for overweight and obese individuals.

ISSN:0889-4655    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Currently 17 million Americans have diabetes mellitus (DM); 90% of these have type 2 DM. Of these 17 million, 5.9 million remain undiagnosed. The undiagnosed patient with type 2 DM may be asymptomatic for years, while hyperglycemic injury to target organs occurs long before the development of frank diabetes. The prevalence of diabetes among adults is estimated to increase to almost double the present number by 2025. People with diabetes and at risk for diabetes are also at risk for cardiovascular disease. Several investigators have now demonstrated the benefit of controlling blood glucose levels as well as other risk factors in this population to decrease the incidence of microvascular and macrovascular disease. Prevention or delaying the onset of type 2 DM can be accomplished with a program of diet, weight loss, and exercise.

ISSN:0889-4655    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

More than one third of all Americans have high or high-normal blood pressure and are at risk for stroke, cardiovascular disease, kidney disease, and heart failure. Many of these are not diagnosed or are inadequately treated. The large number of untreated individuals at risk for the complications of hypertension, or who have not achieved goal pressures on therapy, require a concerted effort by health care professionals to screen and treat this condition. Aggressive identification and treatment of even high-normal hypertension can reduce adverse outcomes. The importance of aggressive management is outlined in this article.

ISSN:0889-4655    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Prescribing exercise for cardiac patients is comparable in many ways to prescribing medications; that is, one recommends an optimal dosage according to individual needs and clinical status. Recent research has shown that it is more accurate to prescribe exercise as a percentage of the oxygen uptake reserve (VO2R), which is the difference between resting and maximal or peak oxygen consumption, rather than as a percentage of the VO2max. Moreover, it appears that a minimum of 1600 kcal/week of leisure-time physical activity may halt the progression of coronary artery disease, whereas regression may be achieved with a gross energy expenditure of 2200 kcal/week. Upper body and resistance training have also been shown to be safe and effective for clinically stable patients. Aerobic capacity serves as an independent predictor of all cause and cardiovascular mortality in patients referred to an outpatient cardiac rehabilitation program, with each 1 metabolic equivalent increase in aerobic fitness conferring an approximate 10% reduction in mortality. The goal of preventing recurrent cardiac events is, to a large extent, based on sustained compliance to multifactorial interventions, which can be influenced by numerous socioeconomic and clinical variables, and enhanced by home-based or group cardiac rehabilitation programs that are designed to circumvent or attenuate barriers to participation and adherence, so that many more individuals may realize the benefits that secondary prevention can provide.

ISSN:0889-4655    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Patients who have been restricted to bed rest following myocardial infarction or cardiac artery bypass grafting routinely develop orthostatic hypotension or frank syncope during their initial attempt at ambulation. Orthostatic intolerance and reduced exercise capacity secondary to bed rest is accompanied by reduced circulating blood volume, lower cardiac output, attenuated cardiac baroreflex responses, and limited baroreflex-mediated vasoconstrictive reserve. Data from the literature provides compelling evidence that the deconditioning effects of bed rest are independent of the disease state and associated with the absence of regular exposure to orthostatic stress. When orthostatic stress is repeatedly increased during bed rest by application of reverse gradient garments, lower body negative pressure, or standing upright, improved orthostatic and exercise performances are associated with restoration of circulating blood volume, maintenance of cardiac output, accentuated cardiac baroreflex responsiveness, and enhanced baroreflex-mediated vasoconstrictive reserve. The available data indicate that the inability of cardiovascular mechanisms to adequately compensate for the orthostatic stress induced by the upright posture is the most important factor limiting functional performance after bed rest, particularly in middle-aged men. Intermittent exposure to orthostatic stress during the bed rest stage of hospital convalescence and recovery phase at home may obviate much of the deterioration in cardiovascular performance that follows myocardial infarction.

ISSN:0889-4655    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

In addition to the well-established cardiovascular risk factors of elevated total and low-density lipoprotein cholesterol, hypertension, and cigarette smoking, multiple additional factors are suspected culprits in both the development and progression of atherothrombosis. It is key for the clinician to critically review research findings utilizing an organized framework in order to credibly advise the patient with cardiovascular disease or at risk for its development. The current evidence and recommendations regarding the following “novel” or “emerging” risk factors will be reviewed: lipoprotein(a), hyperhomocysteinemia, C-reactive protein, infectious processes, fibrinogen, and microalbuminuria.

ISSN:0889-4655    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

The interplay of genetic and environmental factors places first-degree relatives of individuals with premature coronary heart disease at greater risk of developing the disease than the general population. Disease processes, such as dyslipidemia, hypertension, and glucose and insulin metabolism, and lifestyle habits, such as eating and exercise patterns, as well as socioeconomic status aggregate in families with coronary heart disease. The degree of risk associated with a family history varies with the degree of relationship and the age at onset of disease. All individuals with a family history of premature heart disease should have a thorough coronary risk assessment performed, which can be initiated in an office visit. Absolute risk for coronary heart disease determination will predict the intensity of preventive interventions. This article reviews the components of risk determination and primary prevention in individuals with a strong family history of coronary heart disease.

ISSN:0889-4655    

出版商:OVID    

年代:2003

数据来源: OVID