ABSTRACT
Preventive cardiology visits have traditionally focused on educating patients about disease risk factors and the need to avoid and manage them through lifestyle changes and medications. However, long-term patient adherence to the recommended interventions remains a key unmet need. In this review we discuss the rationale and potential benefits of a paradigm shift in the clinician-patient encounter, from focusing on education to explicitly discussing key drivers of individual motivation. This includes the emotional, psychological, and economic mindset that patients bring to their health decisions. Five communication approaches are proposed that progress clinician-patient preventive cardiology conversations, from provision of information to addressing values and priorities such as common health concerns, love for the family, desire of social recognition, financial stressors, and desire to receive personalized advice. Although further research is needed, these approaches may facilitate developing deeper, more effective bonds with patients, enhance adherence to recommendations and ultimately, improve cardiovascular outcomes.
Subject(s)
Cardiology , Cardiovascular Diseases , Cardiovascular Diseases/prevention & control , Communication , Humans , Motivation , Patient ComplianceABSTRACT
Cardiovascular disease is the leading cause of death in women and the treatment of dyslipidemia is a cornerstone of secondary prevention. Pharmacologic therapy with statins can lower LDL-C by 30-50% and reduce the risk of recurrent coronary heart disease in both men and women. While significant reductions in LDL-C can be achieved with statin therapy, diet and lifestyle modification remain an essential part of the treatment regimen for cardiovascular disease. Moreover, a large proportion of the U.S. population is sedentary, overweight, and does not consume a heart-healthy diet. Non-pharmacologic treatment strategies also improve other cardiovascular risk factors and are generally easily accessible. In this review, we examine the effect of non-pharmacologic therapy on lipids as part of the secondary prevention strategy of cardiovascular disease in women.
ABSTRACT
Since the pioneering work of John Gofman in the 1950s, our understanding of high density lipoprotein cholesterol (HDL-C) and its relationship to coronary heart disease (CHD) has grown substantially. Numerous clinical trials since the Framingham Study in 1977 have demonstrated an inverse relationship between HDL-C and one's risk of developing CHD. Over the past two decades, preclinical research has gained further insight into the nature of HDL-C metabolism, specifically regarding the ability of HDL-C to promote reverse cholesterol transport (RCT). Recent attempts to harness HDL's ability to enhance RCT have revealed the complexity of HDL-C metabolism. This review provides a detailed update on HDL-C as an evolving therapeutic target in the management of cardiovascular disease.
Subject(s)
Cardiovascular Diseases/drug therapy , Cholesterol, HDL/drug effects , Hypolipidemic Agents/pharmacology , Animals , Cardiovascular Diseases/diet therapy , Cardiovascular Diseases/metabolism , Cholesterol, HDL/metabolism , Clinical Trials as Topic , Drug Therapy, Combination , Humans , Risk Factors , Smoking CessationABSTRACT
Cardiovascular disease claims more lives each year than the other 4 leading causes of death combined. Current prevention and treatment models focus on low-density lipoprotein cholesterol (LDL-C). In 2001, the National Cholesterol Education Program/Adult Treatment Panel III established new risk categories as well as new LDL-C targets especially for high-risk individuals. Since the implementation of these new guidelines, several relevant clinical trials have been published. The results of these trials suggest that lower LDL-C levels confer a more favorable cardiovascular outcome in high-risk individuals. The idea that low levels of LDL-C are related to a halt in atherosclerosis or even plaque regression has been entertained and investigated. Recent studies conducted exclusively on individuals with known diabetes have provided an important insight on how to appropriately manage diabetic dyslipidemia.
