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Collaboration, patient-centered care critical to CVD treatment
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MIAMI — Strong collaboration and patient-centered focus are among the essential take-home messages for physicians in the prevention and treatment of CVD, Salim S. Virani, MD, PhD, FACC, FAHA, said during a presentation at the National Lipid Association Scientific Sessions.
Cardiology Today previously reported on the primary prevention guidelines from the American College of Cardiology and American Heart Association, which focused on greater collaboration and shared decision-making and less of an emphasis on aspirin use as a primary means of prevention, that were unveiled during the 2019 ACC Scientific Sessions.
“Remember, we are not just talking atherosclerotic CVD, we are also talking about HF and we are talking about AF as well,” Virani, a staff cardiologist Michael E. DeBakey Veterans Affairs Medical Center and an associate professor at Baylor College of Medicine in Houston, said. “Some therapies we’re talking about like diet, physical activity, the newer diabetes medications, hypertension, they don’t only affect atherosclerotic CVD risk, but they also impact HF risk in the future as well as AF to some extent.”
A team-based approach
The promotion of healthy lifestyles is the most important aspect of the guidelines, according to Virani.
The team-based approach in care of patients can also play a significant role in reducing CV risk, he said.
“A physician can only do so much in the 15 minutes that with a patient, but it’s a team sport,” Virani said. “When we have nurse practitioners, physician assistants and dietitians part of a CV risk team, outcomes are better.
Understanding the risks posted by social determinants of health in patients also plays an important role in prevention and treatment, he said.
Virani said recommending five servings of fruits and vegetables or a 30-minute walk daily could prove difficult for a patient that lives in a food desert or has housing instability, respectively.
Adults between 40 and 75 years of age should undergo a 10-year ASCVD risk estimation and have a physician discussion about the use of pharmacological therapy, Virani said.
Additional risk-factor assessments should also be performed in order to help make better decisions about preventive interventions, Virani said in the presentation.
Ongoing management
The implementation of a healthy diet, vigorous physical activity and lifestyle changes such as smoking cessation and altering dietary and activity habits in patients with type 2 diabetes were also stressed during the presentation.
The use of aspirin should be infrequent in the routine of primary prevention of ASCVD due to a “lack of net benefit,” based on data from the ARRIVE, ASCEND and ASPREE studies, Virani said.
Other take-home messages included the endorsement of statin therapy as a primary prevention treatment as well as the recommendation of nonpharmacological interventions for adults with elevated BP or hypertension.
Virani said clinicians should look at CVD prevention beyond the scope of ASCVD and have a continual discussion on the issue.
“What I’d like to emphasize is that it is a team sport and we have to address all of these,” he said. “We will not talk about which risk factor to work on first. It’s an ongoing thing.” – by Earl Holland Jr.
Reference:
Virani SS. A Quick Overview of the 2019 ACC/AHA Guideline On the Prevention of Cardiovascular Disease. Presented at: National Lipid Association Scientific Sessions; May 16-19, 2019; Miami.
Disclosure: Virani reports no relevant financial disclosures.