Cardiology clinics
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Cardiovascular disease prevention is a continuum that encompasses the life-course. This article discusses preventive strategies focusing on policy and clinical initiatives including primordial prevention (lifestyle changes involving smoking, diet and exercise), primary prevention (risk factor control), and secondary prevention (acute and chronic disease management). Combined use of all the three strategies can have an immediate and large impact on reducing CVD morbidity and mortality.
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Cardiovascular disease (CVD) still ranks as the top cause of mortality worldwide. Lipid-modifying therapy has revolutionized the treatment of the disease and is partly responsible for the recent decline in deaths due to CVD. Treatment strategies have evolved since the introduction of the earlier lipid-lowering agents (fibrates, niacin, bile acid resins) to the advent of statins, which have become the standard drugs in cholesterol therapy. The strategy of using high-intensity statin therapy as the initial treatment approach in high-risk individuals, rather than focusing on specific cholesterol levels alone, remains a subject of debate.
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Observational studies with incidence of cardiovascular disease (CVD) events have typically provided the information that is used. Prediction of risk is dependent on accurate and precise baseline measurements in persons without coronary disease at baseline. Follow-up of 5 to 10 years is a typical interval of interest for the prediction of coronary disease events in adults who are asymptomatic at the baseline. Performance criteria for risk estimation include discrimination, calibration, and reclassification, and newer heart disease risk factors and biomarkers can be evaluated in the context of existing risk estimation approaches.