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INTRODUCTION

Cardiovascular disease is now the leading cause of death worldwide; prevention is targeted at modifiable atherosclerosis risk factors (Table 202-1). Identification and control of these attributes reduce subsequent cardiovascular event rates.

TABLE 202-1ESTABLISHED ATHEROSCLEROTIC RISK FACTORS

ESTABLISHED RISK FACTORS

Cigarette Smoking

Cigarette smoking increases the incidence of, and mortality associated with, coronary heart disease (CHD). Observational studies show that smoking cessation reduces excess risk of coronary events within months; after 3–5 years, the risk falls to that of individuals who never smoked. Pts should be asked regularly about tobacco use, followed by counseling and, as needed, antismoking pharmacologic therapy to assist cessation.

Lipid Disorders

(See Chap. 178) Both elevated LDL and low HDL cholesterol are associated with cardiovascular events. Each 1-mg/dL increase in serum LDL correlates with a 2–3% rise in CHD risk; each 1-mg/dL decrease in HDL heightens risk by 3–4%. Fasting screening lipid profile in adults should include total cholesterol, triglycerides, HDL, and LDL (calculated or directly measured). Recommended dietary and/or pharmacologic approach depends on presence or risk of coronary artery disease (CAD); treatment should be most aggressive in pts with established CAD and in those with “equivalent risk” (e.g., presence of diabetes mellitus). Current guidelines by American Heart Association/American College of Cardiology recommend statin therapy for four specific groups of pts at highest risk (Table 202-2). In pts with isolated low HDL, encourage beneficial lifestyle measures: smoking cessation, weight loss, and increased physical activity (see Chap. 178).

TABLE 202-2GROUPS RECOMMENDED FOR STATIN THERAPY

Hypertension

(See Chap. 117) Systolic or diastolic bp > “optimal” level of 115/75 mmHg is associated with ...

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