Cardiology ACCP 2023 pdf
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- Author: Kimma Sheldon
- Pages: 814
- Language: English
- Format: PDF
- Size:10.6 MB
CONTENTS :
. Primary Prevention of Cardiovascular Disease and Public Health
. Dyslipidemia
. Blood Pressure Management in Adult Patients
. Stable Atherosclerotic Disease
. Anticoagulation
. Arrhythmias
Drug-Induced Cardiovascular Disease and Drugs to Avoid
. In Cardiovascular Disease
. Chronic Heart Failure
. Decompensated Heart Failure
. Heart Transplant and Mechanical Circulatory Support
. Acute Coronary Syndrome
. Cardiovascular Emergencies
. Pulmonary Arterial Hypertension
. Specialized Topics in Cardiovascular Disease
. Translation of Evidence into Practice
. Principles of Cardiology Pharmacy Practice Administration
. Pharmacogenomics of Cardiovascular Disease
INTRODUCTION
A. Background:
1. CVD was responsible for 19.1 million deaths globally in 2020.
2. CVD remains the leading cause of death in adults in the United States.
a. In 2019, coronary heart disease (CHD) was the leading cause of CVD death (41.3%).
b. Stroke accounted for 17.2% of CVD deaths in 2019.
3. Use of population-based strategies and affordable cost-effective interventions may reduce morbidity
and mortality throughout the world.
a. Most in U.S. with myocardial infarction (MI) have at least 1 risk factor for CVD prior to event
b. Increasing a patient’s number of “ideal” CV health factors has been associated with reduced inci-
dence of ASCVD events
B. Campaigns and efforts to reduce the development and progression of CVD continue.
1. Healthy People 2020
2. Million Hearts Initiative by U.S. Department of Health and Human Services
3. Million Hearts Cardiovascular Risk Reduction Model
4. American Heart Association (AHA): Make the Effort to Prevent Heart Disease with Life’s Simple 7
a. Defined model of “ideal cardiovascular health”
b. “Life’s Simple 7”
1. Manage blood pressure.
2. Control cholesterol.
3. Reduce blood glucose.
4. Get active.
5. Eatbetter.
6. Lose weight.
7. Stop smoking.
c. The 2018 Cardiovascular Health Promotion Series from Journal of American College of Cardiology
may assist clinicians in facilitating targeted care to patients towards this goal.
C. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease provides recommenda-
tions on aspirin, physical activity, tobacco use, team-based care, shared decision making, and social deter-
minants of health to organize care for the primary prevention patient
1. Team-based care is suggested to improve risk factor control
2. Shared decision making is important to facilitate patient engagement and improve overall health
3. Social determinants should be assessed to prevent ASCVD risk escalation and development
II. ATHEROSCLEROTIC CARDIOVASCULAR DISEASE RISK FACTORS
A. Age, Sex, Race/Ethnicity
1. Prevalence of CVD increases with age in men and women.
2. CVD death is more common in men than in women overall, though it tends to be higher in non-
Hispanic black women than in non-Hispanic black men.
3. Age-adjusted death rates for CHD are higher in non-Hispanic black women than in non-Hispanic white
or Hispanic women.
B. Family History
1. Shared genetic predisposition and lifestyle habits
2. Paternal occurrence of early myocardial infarction (MI) increases the risk for male children by 200%
and for female children by 70% (Circulation 2001;104:393-8). In this study, parental MI in those younger
than 60 years conferred a greater risk of CVD than did parental MI at older ages.
C. Hypertension
1. Increases risk of CHD in a log-linear relationship
2. Those with HTN likely to develop atherosclerotic cardiovascular disease (ASCVD) 5 years earlier than
in normotensive peers
3. Every systolic blood pressure (SBP) increase of 20 mm Hg is associated with a 2-fold increase in
CVD death.
4. Every diastolic blood pressure (DBP) increase of 22 mg Hg is associated with a 2-fold increase in
CVD death.
5. Increased prevalence in men to age 64; then increased prevalence in women
6. Remains underrecognized, with almost one of every six individuals unaware of diagnosis
7. Key prevalence rates in various populations:
a. Patients 60 years and older: 67.2%
b. Patients 8–17 years of age: 11%
c. Non-Hispanic black men: 45%
d. Non-Hispanic black women: 46.3%
D. Hyperlipidemia
1. Cholesterol deposits in the endothelial lining of arterial vessels are the primary cause of atherosclerosis.
2. The 2013 American College of Cardiology/American Heart Association (ACC/AHA) blood cholesterol
guideline recommendations suggest that more than 45 million Americans without ASCVD will benefit
from statin initiation, given expected rates of high cholesterol.
3. The 2018 ACC/AHA blood cholesterol guidelines suggest further tailoring of recommendations to
patient-centered decision making.
4. Low HDL is associated with an increased risk of ASCVD, but this is not a current therapy target
because pharmacologic interventions to raise HDL have not been proven beneficial.
E. Diabetes
1. More than 37 million adults have diabetes: 28.7 million individuals diagnosed (including 28.5 million
adults), 8.5 million undiagnosed.
2. Relative risk of CHD is 1.38 times higher, and for CHD death, risk is 1.86 times higher for each decade
an individual lives with diabetes.
3. In those with diabetes studied in Framingham Heart Study, body habitus further increased ASCVD rates.
a. Women with a normal weight and diabetes had a 54.8% incidence of ASCVD compared with
women with obesity, who had a 78.8% incidence of ASCVD.
b. Men with normal weight and diabetes had a 78.6% rate of ASCVD compared with men with obe-
sity, who had an 86.9% incidence.
4. In adults with diabetes older than 65, 68% die of heart disease and 16% die of stroke.
F. Tobacco Use
1. Almost one in three ASCVD deaths in adults older than 35 are attributable to smoking or secondhand
smoke exposure.
2. Mortality is 3 times higher for U.S. smokers than for those who never smoked.
3. Both smoking and smokeless tobacco increase the risk of all-cause mortality and are established risk
factors for ASCVD.
4. ASCVD risk increases with low overall cigarette primary and secondary exposures.
5. Smoking rates are inversely associated with family income: 20.2% making less than $35,000, 14.1%
making $35,000–$74,000, 10.5% making $75,000–$99,900, and 6.2% making at least $100,000. This
original statistic is from 2015; the new statistic is from 2020 (CDC Burden of Cigarette Use in the U.S.).
6. Since the U.S. Surgeon General’s report in 1965, age-adjusted rate of smoking has declined from 51%
to 14.1% (CDC Current Cigarette Smoking Among Adults in the United States) for men and from 34%
to 11.0% (CDC Current Cigarette Smoking Among Adults in the United States) for women, showing the
success of public health interventions.
7. Smoking cessation decreases ASCVD risk after 1 year, and risk returns to that of nonsmokers after
10 years of discontinuation, whereas stroke risk returns to that of nonsmokers within 2–5 years after
discontinuation.
8. Electronic cigarettes (e-cigarettes) are now used by 1 in 20 individuals in United States.
9. User rates of disease development in those who use e-cigarettes compared with those who do not use
e-cigarettes or any tobacco products (Vindhyal 2019):
a. 56% more likely to have MI
b. 30% more likely to have cerebrovascular accident (CVA)
c. 25% more likely to have coronary artery disease
d. 55% greater rates of depression
G. Physical inactivity
1. Approximately 1 in 3 U.S. adults do not engage in leisure time physical activity.
2. Less than 28% of high school aged teens meet AHA recommendations for performing 60 minutes of
exercise daily.
H. Obesity
1. Obesity prevalence increased from 30.5% (1999–2000) to 41.9% (2019–2022) in the United States.
2. Worldwide, the percentage of overweight or obese adults increased to 41.8% of males and 41.8% of
females as of 2017 (CDC National Health Statistics Reports).
3. The Global Burden of Disease study statistical model suggests Pacific Island countries have the greatest
mortality rate associated with high body-mass index (BMI).
III. RISK ASSESSMENT TOOLS AND CALCULATORS
A. INTERHEART Study: Showed that risk factors account for over 90% of population risk of first MI.
Commonly recognized risk factors for developing CVD are noted in Table 1.
