Who should participate in a Preventive Cardiology Program?
Cardiovascular disease is the number one killer of men and women in the United States. If you want to lower your risk for cardiovascular disease, or more importantly, if you have risk factors or have already been diagnosed with cardiovascular disease, this program is for you. Even if you already have cardiovascular disease, you can slow its progression by managing your risk factors.
What types of patients are seen in the Preventive Cardiology Clinic?
Patients in the Preventive Cardiology Clinic can be categorized as receiving primary or secondary prevention.
* Primary prevention is aimed at the prevention of heart and blood vessel disease before an event such as a heart attack or stroke, or the need for cardiovascular surgery occurs.
* Secondary prevention targets individuals after they have experienced an event such as heart or vascular surgery, angioplasty or heart attack, to prevent further progression of cardiovascular disease.
Who is the clinical team?
The Preventive Cardiology program brings together the multi-specialty expertise of physicians, nurse practitioners, nurses and other health care professionals from several departments, including:
* __________ Cardiovascular Medicine
* Endocrinology
* Hypertension
* Internal Medicine
* Exercise Physiology
* Psychology
* Nutrition Therapy
In bringing these diverse areas together under one program, patients benefit from this comprehensive, multi-specialty expertise and application of the most current, research-based preventive therapies.
How do I enter the program?
Your doctor can arrange for you to be seen in the Preventive Cardiology Program or you may contact us directly to schedule an appointment at 215.444.9353. Once your appointment is made, you will receive information and instructions to prepare you for your first visit.
What role does my primary physician have?
The Preventive Cardiology specialists will work closely with you and your family physician or cardiologist to design a program which fits with your overall health profile. They will track your progress and report this information to you and your doctor with each visit.
What are the program goals?
The team works with each patient individually, using research-based interventions and a variety of treatment methods to decrease risk factors for cardiovascular disease progression and improve quality of life. Your goals will be individualized to your needs and lifestyle.
Patients begin with a complete risk assessment and lab work including biochemical and genetic markers, followed by a long term plan for reducing risk. Nutritional counseling, exercise instruction, advice about lifestyle and behaviors, smoking cessation, medical management of risk factors, psychological counseling and referral to physicians or other health professionals as needed may all be a part of this plan.
What happens during my first visit?
You will receive a thorough risk factor assessment including family history of cardiovascular diseases, assessment of lifestyle health behaviors, review of your cardiovascular and other medical history, lab work including diabetes and cholesterol screening and a focused cardiovascular physical. We also screen for new and emerging risk factors for heart disease, such as homocysteine, fibrinogen, lipoprotein(a) and C-reactive protein. Review common risk factors for heart disease.
What happens next?
The data obtained from your comprehensive evaluation is reviewed by members of our multidisciplinary team, and an individualized treatment plan is created that includes specific goals to be followed over time. Your information is entered into a computerized database, and you will be provided with a sheet to track your information. This database will make it easy for you and your healthcare providers to follow your progress, comparing trends over time. The database also allows for analyses of outcomes to help us evaluate how well we are meeting the goals of our patients. A copy of these records can automatically be sent to your referring physician and any other physicians you would like to be kept informed of your care.
How often will I have follow-up appointments?
Most patients have a follow-up appointment every 3 months, but they may be more or less frequent depending on their individual needs and plan of care. Regular follow-up visits are important to ensure progress toward goal achievement. If you have questions in between visits, you may contact your Preventive Cardiology team.
Risk factors
Causes & Risks
* Development
* Risk factors
Cardiovascular disease includes a number of conditions affecting the structures or function of the heart, including coronary artery disease and vascular (blood vessel) disease. Cardiovascular disease is by far the leading cause of death in the United States.
Who is affected by coronary artery disease?
Heart disease is the leading cause of death in the United States in men and women. Coronary artery disease affects 16.8 million Americans. The American Heart Association (AHA) estimates that about every 34 seconds, an will have a heart attack. In addition, the lifetime risk of having cardiovascular disease after age 40 is 2 in 3 men and more than 1 in 2 women.
Reference: Heart Disease and Stroke Statistics 2009 Update:
A Report from the American Heart Association Committee and Subcommittee.
Circulation, 2009 January 27
Research about cardiovascular disease risk factors suggests that making even small lifestyle changes can reduce the risk of coronary artery disease, heart attack, stroke and other serious cardiovascular conditions.
What are the risk factors for coronary artery disease?
Risk factors are certain conditions that increase a person’s risk for cardiovascular disease. It is important to know:
* Some risk factors, called "nonmodifiable risk factors," cannot be changed.
* Some risk factors, called "modifiable risk factors," can be modified, controlled or treated.
* The more risk factors you have, the greater your chance of developing cardiovascular disease.
* Higher levels of each risk factor correlate with a higher risk for cardiovascular disease.
Nonmodifiable risk factors
Check which ones apply to you
1. Increasing age
Cardiovascular disease is more likely to occur as you get older. About 85 percent of people who die of coronary artery disease are age 65 or older.
2. Male gender
Men have a greater risk of heart attack then women.
3. Menopause
After menopause, a woman's risk of cardiovascular disease increases, but does not reach the level of a man's.
4. Family history
Your risk of cardiovascular disease increases if your parents, brothers, sisters, or children have the disease.
5. Race
The risk of cardiovascular disease is higher in African Americans, Mexican Americans, American Indians, native Hawaiians and some Asian Americans. This increased risk is partly due to higher rates of high blood pressure, obesity and diabetes in these populations.
Since you can't change any of these risk factors, it is important to focus on the risk factors you CAN change.
Risk Factor Goals
You, along with support from your family and friends, can work to achieve the following goals to change or treat your modifiable risk factors and reduce your risk of cardiovascular disease. If you already have cardiovascular disease, you can follow these guidelines to help prevent its progression. (check which ones apply to you)
6. Stop smoking
* Smoking is the most preventable risk factor for cardiovascular disease and stroke.
* Smokers (including cigarette, pipe and cigar smokers) have more than twice the risk of a heart attack than nonsmokers.
* Smoking is also the biggest risk factor for sudden cardiac death. Even one to two cigarettes a day greatly increases the risk of heart attack, stroke and other cardiovascular conditions.
* Nonsmokers who are exposed to constant smoke also have an increased risk.
* Goal: Eliminate the use of all tobacco products. Stay away from other's smoke
Learn more: Smoking and Heart Disease
7. Lower your total cholesterol, LDL (bad) cholesterol and triglyceride levels.
Excessive lipids (fatty substances including cholesterol and triglycerides), especially in the form of LDL cholesterol, cause the build-up of fatty deposits within your arteries, reducing or blocking the flow of blood and oxygen to your heart.
* There’s a sharp increase in the risk for cardiovascular disease when total cholesterol levels are 240 mg/dl and above.
Goals: Total cholesterol less than 200 mg/dl
* LDL cholesterol should be less than 70 mg/dl for those with heart or blood vessel disease and other patients at very high risk of cardiovascular disease, such as those with metabolic syndrome. LDL cholesterol should be less than 100 mg/dl for those who have a high risk of cardiovascular disease, such as some patients with diabetes or those who have multiple heart disease risk factors. For all others, LDL cholesterol should be less than 130 mg/dl.
* Triglycerides less than 150 mg/dl.
It is recommended to have your cholesterol level checked as early as age 20 or earlier if you have a family history of high cholesterol. The cholesterol profile includes an evaluation of total cholesterol, HDL, LDL and triglyceride levels. Your health care provider can tell you how often to have your cholesterol tested.
8. Raise your HDL (good cholesterol).
HDL cholesterol takes the LDL (bad) cholesterol away from the arteries and back to the liver where it can be passed out of the body. High levels of HDL seem to protect against cardiovascular disease.
* Goal: HDL greater than 40 mg/dl; the higher the HDL level, the better.
Learn more: Cholesterol Guidelines
9. Lower high blood pressure
Blood pressure is a measurement of the pressure or force inside your arteries with each heartbeat.
* High blood pressure increases the workload of the heart and kidneys, increasing the risk of heart attack, heart failure, stroke and kidney disease.
* High blood pressure is the biggest risk factor for stroke.
* Goal : 120/80 mmHg or lower (high blood pressure is 140/90 or higher)
Control blood pressure through diet, exercise, weight management, and if needed, medications. Also limit alcohol, as it can increase your blood pressure.
Learn more: Your Blood Pressure
Learn more: Strategies to Control Blood Pressure
10. Control Diabetes
Diabetes occurs when the body is unable to produce insulin or use the insulin it has. This results in elevated blood sugar levels.
* People with diabetes (especially women) have a higher risk of cardiovascular disease because diabetes increases other risk factors, such as high cholesterol, LDL and triglycerides; lower HDL; and high blood pressure.
* Keeping diabetes under control is essential in reducing your risk.
* Goal : Hemoglobin A1c test less than 7.0% if you have diabetes, and less than 6.0% if you do not have diabetes. Follow-up with your doctor on a regular basis.
* Learn more: Cleveland Clinic Health Information Center
11. Maintain a healthy body weight
The more you weigh, the harder your heart has to work to give your body nutrients.
* Research has shown that being overweight contributes to the onset of cardiovascular disease.
* Excess weight also raises blood cholesterol, triglycerides and blood pressure, lowers HDL cholesterol and increases the risk of diabetes.
* How a person’s weight is distributed also is important. People who carry their weight in the middle have a greater risk of developing cardiovascular disease, compared to people who carry their weight in their arms and legs. Waist measurements are one way to determine fat distribution.
* Weight is best determined by calculating Body Mass Index (BMI). BMI is a figure calculated from your height and weight. Doctors often use BMI as an objective indicator of whether a person is overweight, underweight, or at a healthy weight, and it is recommended by the National Institutes of Health for this purpose.
To calculate your BMI, divide weight in kilograms (kg) by height in meters squared (m2).
Metric conversions are: pounds divided by 2.2 = kg; inches multiplied by 0.0254 = meters.
For example, a woman who weighs 140 pounds and is 5 feet, 6 inches tall has a BMI of 23.
140 lbs divided by 2.2 = 64 kg
5’6” = 65” x 0.0254 = 1.65
1.652 = 2.72
64 divided by 2.72 = 23
Your health care provider can help you calculate your BMI.
* Goals: A normal BMI ranges from 18.5 to 24.9 kg/m2. Overweight is defined as having a BMI higher than 25 kg/m2. A BMI higher than 30 kg/m2 is considered obese.
* Waist measurements for women should be less than 35 inches. Men should aim for a waist less than 40 inches.
* Achieve and maintain a desirable weight. A diet and exercise program will help you reach your goal.
Learn more: Overweight and Heart Disease (includes BMI calculator)
12. Exercise
The heart is like any other muscle – it needs a workout to stay strong and healthy. Exercising helps improve how well the heart pumps blood through your body.
Activity and exercise also help reduce so many other risk factors: You can lower blood pressure, lower high cholesterol, reduce stress, achieve and maintain a healthy body weight, help yourself quit smoking and improve your blood sugar levels.
* Goals: Moderate exercise 30 minutes a day, on most days. More vigorous activities are associated with more benefits.
* Exercise should be aerobic, involving the large muscle groups. Aerobic activities include brisk walking, cycling, swimming, jumping rope and jogging. If walking is your exercise of choice, use the pedometer goal of 10,000 steps a day.
* Consult your doctor before starting any exercise program.
Learn more: Exercise for your health
13. Follow a heart-healthy diet
The old saying, “You are what you eat,” may be truer than ever - especially when it comes to cardiovascular disease. Four risk factors are related to diet: high blood pressure, high blood cholesterol, diabetes and obesity.
* Goals : Eat foods low in sodium, saturated fat, cholesterol, trans fat (partially hydrogenated fats) and refined sugar.
* Omega-3 fatty acids are good fats and come from tuna, salmon, flaxseed, almonds, and walnuts. Mono- unsaturated fats also are preferred and are found in olive and peanut oils.
* Also eat plant-based foods such as fruit and vegetables, nuts and whole grains.
Learn more: Nutrition Strategies
Contributing Risk Factors
Check which ones apply to you
Some risk factors are not considered traditional risk factors, but are still thought to contribute to overall risk for heart disease. These include:
14. Individual response to stress
Although stress is not considered a traditional risk factor, some researchers have noted a relationship between cardiovascular disease risk and stress in a person’s life, their health behaviors and socioeconomic status. Stress may affect established risk factors.
Learn to manage stress by practicing relaxation techniques, learning how to manage your time, setting realistic goals, and trying some new techniques such as guided imagery, massage, __________.
15. Drinking too much alcohol
Intake of too much alcohol can lead to increased blood pressure, heart failure and stroke. It is also linked to high triglycerides, irregular heart beats, obesity, and cancer. Research has shown that those who drink one drink per day (4 oz. of wine, 12 oz. of beer, or 1– 1/2 oz. of 80-proof spirits) may have less risk. However, the American Heart Association does not recommend that non-drinkers start using alcohol or that drinkers increase the amount they drink.
Know your risk factors
If you have a family history of cardiovascular disease or high cholesterol, it is even more important to decrease your other risk factors. Get your cholesterol levels tested every year. Make sure you follow-up with your health care provider every year for a checkup.
* Ask your doctor about the ultra-sensitive C-reactive protein (us-CRP) blood test. High us-CRP levels are related to an increased risk of heart attack, stroke, peripheral vascular disease and restenosis (reclosing) of the arteries after angioplasty procedures.
* Homocysteine is a protein in the blood. High levels of homocysteine -- above 10 -- are associated with an increased risk of cardiovascular disease. There have been conflicting studies about the benefits and risks related to treatment of elevated homocysteine levels with folic acid and B vitamins. Therefore, ask your doctor before taking these supplements.