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• W1992023484 abstract "Remarkable advances in our knowledge regarding coronary disease prevention have occurred over the past 5–10 years, largely due to the contributions of large scale clinical trials. One challenge for this new decade is to maximize implementation of such knowledge into practice. Creative strategies are necessary to achieve appropriate risk assessment and management in traditional and nontraditional health care settings. Improving physicians' practice and attitudes toward prevention one by one is inefficient. We need to improve the “systems” of prevention, and then individuals will follow. A paradigm shift in emphasis from the individual to the system may require re-engineering the field of preventive cardiology. Although the discipline established its roots in lipid clinics, the role of such specialty centers in modern medicine has diminished due to the availability of powerful statin drugs. Many formal lipid clinics have seen numbers dwindle. Cases are frequently limited to the patient with severe hypertriglyceridemia or familial hypercholesterolemia. While these conditions may benefit from a specialist's care, this approach will only reach a limited number of individuals. It is well documented that the largest number of cardiovascular events occur among those whose cholesterol levels fall in the normal to moderate range. Therefore, novel population wide approaches to prevention must be an integral part of the future of preventive cardiology. Advances in communication technology, such as the Internet, provide unique opportunities to deliver prevention messages to large numbers of people. The modern preventive cardiologist has the potential for significant clinical impact using a virtual office as a mechanism to assist patients and physicians. Traditional medical models for prevention have generally focused on the individual with the highest absolute risk of a future cardiovascular event. This strategy has been shown to be cost effective. Despite this, underutilization of efficacious interventions in high risk persons is widely documented. Systematic procedures to identify and treat such individuals should be a top priority of any health system. Critical pathways in coronary care units can facilitate more uniform application of secondary prevention guidelines and may enhance compliance with risk reducing strategies post discharge. An even greater challenge will be to develop models that work in locations which are remote to centralized facilities for health care. A “systems approach” to risk management that promotes integration of prevention into primary care practices will be best positioned to yield the greatest reduction of the cardiovascular disease burden in our society. Theoretically, well designed systems of prevention should be superior to implementation of a high risk individual approach in traditional models, since the latter only benefits those that already have access to a physician. There is a strong rationale for prevention models that maximize opportunities for global risk assessment and comprehensive risk factor management. Information about a constellation of risk factors provides enhanced prediction about future cardiovascular risk and can guide treatment decisions about aggressiveness of risk factor management. Moreover, treatment decisions regarding a single risk factor, such as hypertension, may be influenced by the presence of another risk factor, such as dyslipidemia. Comprehensive risk reduction clinics lend themselves more to coordinated preventive care and provide an opportunity to educate referring physicians and patients about potential interactions when treating risk factors. Establishing centers of excellence for cardiovascular disease prevention will play an important role in setting benchmarks for comprehensive cardiac care. Ideally, such centers will assume leadership roles in developing community outreach programs for screening and prevention. Furthermore, they may serve as fertile training grounds for future generations of preventive cardiologists and others interested in disease prevention. Preventive cardiology has a strong tradition for being a multidisciplinary and collaborative field. A major challenge for many cardiovascular prevention programs is to reach diverse populations that are in the greatest need of risk factor screening and management. Therefore, training programs should include individuals that come from a variety of backgrounds. Cardiologists, endocrinologists, primary care physicians, and pediatricians are ideal candidates for training in preventive cardiology. Special interests in multicultural health, women's health, and the elderly will provide an added focus on high risk populations. To maximize interest in training cardiologists in prevention, programs may include the option to gain credentials in novel diagnostic/screening modalities, such as electron beam computed technology. Formal training in the public health sciences, such as epidemiology or health services research, should be considered as an integral part of training in preventive cardiology. The well rounded preventive cardiology training program should have the ability to provide research exposure to the basic sciences, genetics, vascular biology, clinical trials, and outcomes research. Currently, there are very few centers that have the capacity to provide comprehensive clinical and research training in preventive cardiology. Further development of integrated training programs should be a high priority in the ensuing years. As we move forward into the 21st century, research in the prevention of cardiovascular diseases will be of heightened importance. Recent data suggests the decline in the rate of cardiovascular disease mortality is slowing, and trends vary across gender and ethnic groups. These observations should stimulate research about the socioeconomic, biologic, and cultural determinants of cardiovascular health. More data are needed to understand trends in the incidence of cardiovascular diseases so that prevention efforts can be targeted to areas and populations at highest risk. The incremental value of genetic screening and novel technologies to identify high risk individuals is a major research question to be further addressed. Research is needed on methods to improve lifestyles and the environment. Applied research on how to improve compliance with prevention guidelines in individuals, organizations, and communities should be a high priority. Service delivery models need to be evaluated for their impact on improving clinical outcomes as well as intermediate end points. As the public health burden of cardiovascular disease increases, cost effectiveness research for preventive interventions will be critical as resources remain limited. Dr. Mosca is supported by a Research Career Award from the National Institutes of Health (NHLBI K08 03681)." @default.
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• W1992023484 date "2000-01-01" @default.
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• W1992023484 title "Preventive Cardiology in the New Millennium: A Virtual Specialty?" @default.
• W1992023484 doi "https://doi.org/10.1111/j.1520-037x.2000.80359.x" @default.
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