Preventive Cardiology: Strategies for the Prevention and Treatment of Coronary Artery Disease PDF
Preview Preventive Cardiology: Strategies for the Prevention and Treatment of Coronary Artery Disease
P C REVENTIVE ARDIOLOGY C C ONTEMPORARY ARDIOLOGY CHRISTOPHER P. CANNON SERIES EDITOR Preventive Cardiology: Strategies for the Prevention and Treatment of Coronary Artery Disease, edited by JoAnne Micale Foody, 2001 Blood Pressure Monitoring in Cardiovascular Medicine and Therapeutics, edited by William B. White, 2001 Vascular Disease and Injury: Preclinical Research, edited by Daniel I. Simon and Campbell Rogers 2001 Nitric Oxide and the Cardiovascular System, edited by Joseph Loscalzo and Joseph A. Vita, 2000 Annotated Atlas of Electrocardiography: A Guide to Confident Interpretation edited by Thomas M. Blake, 1999 Platelet Glycoprotein IIb/IIIa Inhibitors in Cardiovascular Disease, edited by A. Michael Lincoff and Eric J. Topol, 1999 Minimally Invasive Cardiac Surgery,edited by Mehmet C. Oz and Daniel J. Goldstein, 1999 Management of Acute Coronary Syndromes,edited by Christopher P. Cannon, 1999 P R E V E NTI V E C ARDIOLOGY Strategies for the Prevention and Treatment of Coronary Artery Disease Edited by J A M F , O NNE ICALE OODY MD Yale University School of Medicine New Haven, CT SPRINGER SCIENCE+BUSINESS MEDIA, LLC © 2001 Springer Science+Business Media New York Originally published by Humana Press Inc. in 2001 AII rights reserved. No part ofthis book may be reproduced. stored in a retrievaT system, or transmitted in any form or by any means, electronic, mechanical, photocopying, mierofilming, reeording, or otherwise without written permis sion from the Publisher. Due diligencehas been taken by the publishers, editors, and authors ofthis book to assure the aecuracy oftheinformation published and to describe generaTly accepted practices. The contributors herein have carefully checked to ensure that the drug selections and dosages set forth in this text are accurate and in accord with the standards accepted at the time of publication. Notwithstanding, since new research, changes in government regulations, and knowledge from clinical experience relating to drug therapy and drug reactions constantly occur, the reader is advised to check the product information provided by the manufacturer of each drug for any change in dosages or for additional warnings and contraindications. This is ofutmost importance when the recommended drug here in is a new or infrequent1y used drug. It is the responsibility of the treating physician to determine dosages and treatment strategies for individual patients. Further, it is the responsibility of the health care provider to ascertain the Food and Drug Administration status of each drug or device used in their clinical practice. The publishers, editors, and authors are not responsible for errors or omissions orfor any consequences from the application ofthe information presented in this book and make no warranty, express or implied, with respect to the contents in this publication. 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Library of Congress Cataloging-in-Publication Data Preventive cardiology : strategies for the prevention and treatment of coronary artery disease / edited by JoAnne Micale Foody. p. ; cm. --(Contemporary cardiology) Includes bibliographical references and index. ISBN 978-1-4757-6241-9 ISBN 978-1-59259-001-8 (eBook) DOI 10.1007/978-1-59259-001-8 1. Coronary heart disease--Prevention. 2. Coronary heart disease--Risk factors. 3. Coronary heart disease- Pathophysiology. 1. Foody, JoAnne Micale. Il. Contemporary cardiology (Totowa, N.J.) [DNLM: 1. Coronary Disease--prevention & control. 2. Coronary Disease--therapy. WG 300 P9457 20001] RC685.C6 P675 20001 616.1 '23--dc21 00-037004 P REFACE Preventive cardiology is a newly emerging field that places emphasis on the preven- tion and treatment of coronary disease. Preventive Cardiology: Strategies for the Preven- tion and Treatment of Coronary Artery Disease is intended for clinical cardiologists, internists, and allied health care professionals who wish to extend their knowledge and expertise in the rapidly expanding field of Preventive Cardiology. It is the mission of this book to provide clinicians with the understanding and tools necessary to practice preven- tion in their daily practices. Recent changes in the delivery of health care in the United States, in conjunction with new scientific evidence supporting the role of preventive strategies in the maintenance of cardiovascular health, have focused new attention and efforts on the field of cardio- vascular disease prevention. The field of cardiology is thus making a gradual transition from the technology-driven, intervention-oriented perspective of the last several decades to a new, preventive, molecular-based perspective. As fresh evidence amasses that pre- ventive measures produce a considerable decrease in the incidence of both primary and secondary cardiac events and mortality, there is growing, widespread acknowledgment that health care providers from all arenas must initiate preventive strategies in the man- agement and care of their patients. Preventive Cardiology as a field has only come into its own in the last several years in response to striking new evidence that preventive strategies may prove to be the best interventions in treatment and prevention of cardiovascular disease. Cardiovascular disease currently claims the lives of 500,000 men and women each year and, despite our best efforts, these numbers will continue to increase. Over the past century, technical advances have provided significant improvements in the treatment of existing coronary artery disease and have come to generate annual cardiovascular health care expenditures in the United States that exceed $100 billion, largely resulting from hospitalizations and revascularization procedures. Cardiology continues to be focused on acute care. Currently, for every dollar spent on cardiovascular disease in this country, only six cents of out-of-hospital medical therapy is spent on reinforcing healthy lifestyles. Increasing costs of medical care have led, in the field of cardiovascular medicine, to cost shifting and a reevaluation of clinical outcomes, cost-effectiveness, and the development of effective health care delivery systems. The incorporation of preventive cardiology strategies into the practice of cardiovascular medicine will be of paramount importance as we begin this new millennium. It is critical to assess the effectiveness of our current clinical strategies and to direct health care efforts and resources toward the preventionof the atherosclerotic process itself. Preventive Cardiology: Strategies for the Prevention and Treatment of Coronary Artery Diseasehopes to provide the clinicians with both the knowledge and the impetus to incorporate preventive strategies into their everyday practices. It will not only provide practical information for the management of patients at risk for cardiovascular disease, but also offers an overview of the new paradigms in the pathophysiology of coronary artery disease. The first part of the book will focus on the unstable atherosclerotic plaque v vi Preface and new strategies for modification of plaque constituents, the important and central role of the endothelium in the maintenance of cardiovascular health, and the emerging roles of oxidative stress, infection, and inflammation in coronary artery disease (CAD). This part will provide novel current perspectives on important emerging concepts in the patho- physiology of coronary atherosclerosis. The book’s second part focuses on traditional cardiovascular risk factors and also provides insights into the gender-specific aspects of CAD risk. These offer thorough, concise reviews of these various risk factors with preventive strategies outlined for the clinician. A significant body of evidence exists that strategies incorporating risk modi- fication provide substantial benefits in patients at risk for or with coronary disease. Coronary atherosclerosis and its sequelae may be largely preventable if aggressive multidisciplinary strategies are implemented. Risk modification may prove to be one of the most significant “interventions” that any physician can perform for their patients with acute coronary syndromes. The final part of the book provides an overview of strategies for the identification of patients at risk for CAD events, a detailed chapter on pharmacologic therapies for easy reference, as well as a review of antiplatelet agents in the prevention of coronary events. Finally, given the imperatives of cost-containment and health care resource allocation, a chapter on the pharmacoeconomics of preventive strategies as well as the implemen- tation of a preventive cardiology clinic are included. The goal of Preventive Cardiology: Strategies for the Prevention and Treatment of Coronary Artery Diseaseis to provide an overview of the exciting opportunities to prevent the progression, and in some instances to regress the process, of coronary atherosclerosis and to incorporate these strategies into the daily practice of clinical medicine. JoAnne Micale Foody, MD C ONTENTS Preface......................................................................................................................... v Contributors............................................................................................................... ix Part I New Paradigms in the Pathophysiology of Coronary Artery Disease 1 The Unstable Plaque: Implications and Opportunities for Prevention............ 3 JoAnne Micale Foody, MD and Steven E. Nissen, MD 2 Endothelial Function and Insights for Prevention ..........................................19 Eric H. Lieberman, MD, Margarita R. Garces, MD, and Francisco Lopez-Jimenez, MD,MSC 3 Role of Antioxidants in Coronary Artery Disease..........................................29 R. Preston Mason, PHD 4 Inflammation and Infection in Coronary Artery Disease ...............................47 Michael A. Lauer, MD Part II Risk Factors and Their Management in Coronary Artery Disease 5 Dyslipidemias and Coronary Artery Disease: Clinical Evidence and Clinical Implications..............................................67 JoAnne Micale Foody, MD 6 Management of Hypertension: Implications of JNC VI..................................99 Donald G. Vidt, MD 7 Diabetes Mellitus, Hyperinsulinemia, and Coronary Artery Disease ..........117 Byron J. Hoogwerf, MD 8 Exercise in the Prevention of Coronary Artery Disease...............................143 Gordon G. Blackburn, PHD 9 Obesity and Coronary Artery Disease: Implications and Interventions.......159 Kristine Napier, MPH,RD 10 Tobacco as a Cardiovascular Risk Factor.....................................................177 Robyn Bergman Buchsbaum, MHS,CHES and Jeffrey Craig Buchsbaum MD,PHD 11 Women and Coronary Artery Disease...........................................................193 JoAnne Micale Foody, MD and Cynthia Pordon, DO 12 A Recognized Risk Factor: Homocysteine and Coronary Artery Disease ...........................................221 Simone Nader, MD and Killian Robinson, MD vii viii Contents Part III Strategies for Prevention 13 Pharmacologic Agents in Preventive Cardiology............................................235 Michael A. Militello, PHARMD and Teresa H. Seo, PHARMD 14 Aspirin and Antiplatelet Agents in the Prevention of Complications of Coronary Artery Disease ............257 Scott A. Moore, MD and Steven R. Steinhubl, MD 15 Exercise Testing and Risk Assessment............................................................283 Christopher R. Cole, MD and Michael S. Lauer, MD 16 Electron Beam Tomography in the Prevention of Coronary Artery Disease.......................................................................303 Arthur Agatston, MD 17 A Multidisciplinary Model for Aggressive Risk Factor Control in Cardiovascular Disease........................................325 Joseph P. Frolkis, MD,PHD 18 Pharmacoeconomics of Cardiovascular Medicine...........................................339 Melanie Oates, PHD,MBA,RN, William F. McGhan, PHARMD,PHD, and Ron Corey, PHD,MBA,RPH Index ..........................................................................................................................357 C ONTRIBUTORS ARTHUR AGATSTON,MD • Director, Mount Sinai Cardiac Prevention Center, Mount Sinai Medical Center of Greater Miami; Associate Professor of Medicine, The University of Miami School of Medicine, Miami, FL GORDON G. BLACKBURN,PHD • Director, Cardiac Health Improvement and Rehabilitation Program, Department of Cardiology, The Cleveland Clinic Foundation, Cleveland, OH ROBYN BERGMAN BUCHSBAUM,MHS,CHES• Education Coordinator, The Heart Center, The Cleveland Clinic Foundation, Cleveland OH JEFFREY CRAIG BUCHSBAUMMD,PHD • Department of Radiation Oncology, The Cleveland Clinic Foundation, Cleveland OH CHRISTOPHER R. COLE,MD • Department of Cardiology, The Cleveland Clinic Foundation, Cleveland OH RON COREY,PHD,MBA,RPH • Global Director, Economic Strategies, Pharmacia Corporation, Peapack, NJ JOANNE MICALE FOODY,MD • Yale University School of Medicine, New Haven, CT JOSEPH P. FROLKIS,MD,PHD • Staff Physician, Sections of Preventive Cardiology and Preventive Medicine, Division of Medicine, The Cleveland Clinic Foundation; Assistant Professor, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH MARGARITA R. GARCES,MD • Division of Cardiology, Mount Sinai Medical Center, Miami Beach Florida and University of Miami School of Medicine, Miami, FL BYRON J. HOOGWERF,MD • Section of Preventive Cardiology, Department of Cardiology, Department of Endocrinology, and Division of Internal Medicine, The Cleveland Clinic Foundation, Cleveland OH MICHAEL A. LAUER,MD • Department of Cardiology, Borgess Medical Center Research Institute, Kalamazoo, MI MICHAEL S. LAUER,MD • Department of Cardiology, The Cleveland Clinic Foundation, Cleveland, OH ERIC H. LIEBERMAN,MD • Division of Cardiology, Mount Sinai Medical Center, Miami Beach Florida and University of Miami School of Medicine, Miami, FL FRANCISCO LOPEZ-JIMENEZ,MD,MSC • Division of Cardiology, Mount Sinai Medical Center, Miami Beach Florida and University of Miami School of Medicine, Miami, FL R. PRESTON MASON,PHD • Membrane Biophysics Laboratory, Departments of Biochemistry and Medicine, Cardiovascular and Pulmonary Research Institute, MCP Hahnemann University School of Medicine, Allegheny Campus, Pittsburgh, PA WILLIAM F. MCGHAN,PHARMD,PHD • Professor and Director, Graduate Program in Pharmacy Administration, University of the Sciences, Philadelphia, PA MICHAEL A. MILITELLO,PHARMD • Department of Pharmacy, The Cleveland Clinic Foundation, Cleveland OH ix x Contributors SCOTT A. MOORE,MD • Department of Cardiology, Wilford Hall Medical Center, San Antonio, TX SIMONE NADER,MD • Department of Cardiology, The Cleveland Clinic Foundation, Cleveland, OH KRISTINE NAPIER,MPH,RD • Section of Preventive Cardiology, The Department of Cardiology, The Cleveland Clinic Foundation, Cleveland OH STEVEN E. NISSEN,MD • Vice-Chairman, Department of Cardiology, Director Intravascular Ultrasound Core Laboratory, Department of Cardiology, The Cleveland Clinic Foundation, Cleveland, OH MELANIE OATES,PHD,MBA,RN • Philadelphia College of Pharmacy, University of the Sciences, Philadelphia, PA CYNTHIA PORDON,DO • Department of Cardiology, The Cleveland Clinic Foundation, Cleveland OH KILLIAN ROBINSON,MD • Department of Cardiology, The Cleveland Clinic Foundation, Cleveland OH THERESA H. SEO,PHARMD • Department of Pharmacy, The Cleveland Clinic Foundation, Cleveland OH STEVEN R. STEINHUBL,MD • Department of Cardiology, Wilford Hall Medical Center, San Antonio, TX DONALD G. VIDT,MD • Department of Nephrology and Hypertension, Cleveland Clinic Foundation, Cleveland, OH; Professor of Internal Medicine, Ohio State University, Columbus, OH
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