ABSTRACT
The 2021 guidelines primary panel selected clinically relevant questions and produced updated recommendations, on the basis of important new findings that have emerged since the 2016 guidelines. In patients with clinical atherosclerosis, abdominal aortic aneurysm, most patients with diabetes or chronic kidney disease, and those with low-density lipoprotein cholesterol ≥ 5 mmol/L, statin therapy continues to be recommended. We have introduced the concept of lipid/lipoprotein treatment thresholds for intensifying lipid-lowering therapy with nonstatin agents, and have identified the secondary prevention patients who have been shown to derive the largest benefit from intensification of therapy with these agents. For all other patients, we emphasize risk assessment linked to lipid/lipoprotein evaluation to optimize clinical decision-making. Lipoprotein(a) measurement is now recommended once in a patient's lifetime, as part of initial lipid screening to assess cardiovascular risk. For any patient with triglycerides Ë 1.5 mmol/L, either non-high-density lipoprotein cholesterol or apolipoprotein B are the preferred lipid parameter for screening, rather than low-density lipoprotein cholesterol. We provide updated recommendations regarding the role of coronary artery calcium scoring as a clinical decision tool to aid the decision to initiate statin therapy. There are new recommendations on the preventative care of women with hypertensive disorders of pregnancy. Health behaviour modification, including regular exercise and a heart-healthy diet, remain the cornerstone of cardiovascular disease prevention. These guidelines are intended to provide a platform for meaningful conversation and shared-decision making between patient and care provider, so that individual decisions can be made for risk screening, assessment, and treatment.
Subject(s)
Cardiovascular Diseases/prevention & control , Dyslipidemias/therapy , Adult , Apolipoproteins B/blood , Cholesterol, HDL/blood , Cholesterol, LDL/blood , Dietary Supplements , Eicosapentaenoic Acid/analogs & derivatives , Eicosapentaenoic Acid/therapeutic use , Ezetimibe/therapeutic use , Female , Health Behavior , Humans , Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use , PCSK9 Inhibitors/therapeutic use , Pregnancy , Pregnancy Complications , Primary Prevention/standards , Risk Assessment , Secondary Prevention/standardsABSTRACT
The Women's Healthy Heart Initiative clinic was launched in 2009 at the McGill University Health Centre to provide women with comprehensive primary prevention care. The mission of this nurse-led clinic is to increase awareness among women of their risk of heart disease and to empower them to be proactive in achieving heart health. In this article, the author discusses the findings from an analysis of clinical measures in the clinic's first three years of operation. The clinic has helped patients reduce their blood pressure, cholesterol levels and weight. The clinic's nurses have gained insights into the importance of self-referral and family history in preventive care. The results demonstrate the effectiveness of this collaborative care model in heart disease prevention.
