Collaboration could bring about preventive cardiology subspecialty

SANTA ANA PUEBLO, N.M. — A collaboration between clinical lipidology and preventive cardiology may aid in developing a subspecialty that focuses on the prevention of CVD, according to a presentation at American Society for Preventive Cardiology Congress on CVD.

There currently is a battle between the terms clinical lipidology and preventive cardiology, Sergio Fazio, MD, PhD, director of the Center for Preventive Cardiology and professor of medicine in the Knight Cardiovascular Institute at Oregon Health and Science University in Portland, said in the presentation.

“As we call ourselves lipid specialists or preventive cardiologists, we need to have a good understanding of lipid metabolism and cardiovascular biology,” Fazio said in the presentation. “Lipid metabolism, some people say, is the domain of the endocrinologist, whereas knowledge of vascular biology and physiology is the domain of cardiology.”

Lipid disorders are often found everywhere and typically overwhelm practices that define themselves as those that focus on prevention, according to the presentation.

“However, lipid problems produce consequences that are not just for the heart,” Fazio said.

Some patients require only expert lipid management, while others require only expert CVD risk assessment and management, Fazio said, noting that many hospitals have separate entities for lipid clinics and preventive cardiology, which results in internal competition within the medical center.

“There must be an emergence, a birth of a subspecialty called preventive cardiology, where all the components of CVD risk assessment and management are addressed in a single center with all the appropriate expertise,” Fazio said.

Lipid metabolism is neither an endocrinology nor a cardiology domain, but rather the domain of preventive cardiology, Fazio said.

“The preventive cardiology field is presented with a tremendous opportunity to acquire status as a subspecialty, and trademark confusions and redundancies between clinical lipidology and preventive cardiology only hurt progress and should be addressed urgently,” he said.

He noted that when the field of lipids and prevention first started, it was made up of internists and basic researchers, then as time went on, medical geneticists and other specialists were added to the group, and now cardiologists, endocrinologists and internists make up a most of the experts in this field.

The rate of death from CVD in the United States has been declining, which may be due to updated guidelines, lifestyle changes or improved drug therapy.

“We are doing very good in the population by intervening on the preventive side,” Fazio said.

Oregon Health and Science University created a Center for Preventive Cardiology, which may serve as a model for the subspecialty, Fazio said. This center includes services such as cardiac rehabilitation, daily operation of outpatient services, laboratory for risk assessment, cardiac testing and imaging, genetic counseling and dietary services.

“We as ASPC are well-positioned to take the lead from this charge of making something structured and sustainable out of preventive cardiology,” Fazio said. “It is time to produce the first generation of formally trained subspecialists.” – by Darlene Dobkowski

Reference:

Fazio S. Preventive Cardiology Now and 5 Years from Now: A Strategic Vision. Presented at: American Society for Preventive Cardiology Congress on CVD; July 27-29, 2018; Santa Ana Pueblo, New Mexico.

Disclosure: Fazio reports he served on advisory boards for Aegerion, Akcea, Amarin, Amgen and Kowa.