Preventive Cardiology Experts Call for Enhanced Cardiovascular Risk Assessment and Early Intervention Strategies

Cardiovascular disease (搜索)搜索该疾病 continues to represent a critical health challenge in the United States, prompting leading experts to advocate for enhanced prevention strategies and early intervention approaches. During a recent webinar hosted by The American Journal of Managed Care (搜索)搜索该词条 in association with the American Society of Preventive Cardiology (搜索)搜索该词条, clinicians and researchers outlined significant gaps in current prevention practices and proposed new strategies to address them.

Evolving Understanding of Cardiovascular-Kidney-Metabolic Health

The field of preventive cardiology is experiencing a fundamental shift toward recognizing the interconnected nature of cardiovascular, kidney, and metabolic health. Martha Gulati, MD, MS, FACC, FAHA, FASPC, FESC, cardiologist at the Cedars-Sinai Medical Center查看公司主页 Schmidt Heart Institute, emphasized this evolution.

"I think the interconnectedness is what we have appreciated for some time," Gulati said. "But I think what is exciting is that not just are we talking about it, but there [are] drugs being developed that are changing the cardiovascular and cardiometabolic kidney risk, which we did not have before."

This new understanding requires a team-based approach to patient care, with cardiologists working collaboratively with endocrinologists, nephrologists, and liver specialists rather than treating patients in isolated silos. Gulati noted that this evolution is elevating preventive cardiology as a specialty unto itself, requiring specialized training to think about disease progression in new ways.

Critical Barriers to Prevention

Two primary barriers continue to impede effective cardiovascular disease (搜索)搜索该疾病 prevention: delayed intervention and limited access to care. Alison Bailey, MD, FACC, FASPC, chief of cardiology at Centennial Heart and physician director of cardiovascular disease for HCA Healthcare查看公司主页, highlighted the timing challenge.

"Instead of meeting these people up front, when we really could make more of a profound impact, we're meeting them sort of on the tail end, after they have established disease," Bailey explained. Often, cardiologists encounter patients only after they have experienced a cardiovascular event or have been dealing with uncontrolled hypertension (搜索)搜索该疾病 or lipids for two decades.

Access to care presents an equally significant challenge, particularly in rural areas. "We know there's a rural health crisis, and our patients who live in rural areas don't have physical access to care," Bailey said. "They may not have physicians or care teams that they can go see, but we also have a lack of insurance or underinsured status, and so both of those are big barriers when we're thinking about a lifetime chronic disease."

Emerging Risk Factors and Testing Gaps

Lipoprotein(a) Testing

Lipoprotein(a)查看药品详情 (Lp[a]) has emerged as a critical risk factor that remains significantly underutilized in clinical practice. Nathan Wong, PhD, MPH, FACC, FAHA, FNLA, FASPC, professor and director of the Heart Disease Prevention Program at the University of California, Irvine查看公司主页, explained its significance.

"Recent data show that fewer than 1% of patients actually get Lp(a) tested," Wong said. This represents a substantial gap given that Lp(a) is 6 times more atherogenic than low-density lipoprotein (搜索)搜索该靶点 (LDL) cholesterol and contributes significantly to residual cardiovascular risk even when LDL levels are well controlled.

The National Lipid Association (搜索)搜索该词条 has responded to this gap by updating their guidelines to recommend that adults be tested for Lp(a) at least once in their lifetime. Wong noted that testing appears to motivate greater initiation of lipid-lowering therapy (搜索)搜索该药品 and other preventive practices among patients.

For pediatric populations, children with a family history of cardiovascular disease (搜索)搜索该疾病 or familial hypercholesterolemia (搜索)搜索该疾病 should be tested during later childhood or adolescence. Gulati added that women should be retested if they were borderline during their initial screening once they reach menopause, as Lp(a) levels can increase during this transition.

Additional Risk Markers

Beyond Lp(a), experts identified several other emerging risk factors that warrant attention. The urine albumin-creatinine ratio (搜索)搜索该靶点, which measures protein in urine, represents an actionable risk marker with available therapeutic interventions when elevated. Coronary calcium (搜索)搜索该靶点 scoring also provides valuable risk stratification and can guide statin查看药品详情 therapy decisions.

However, current risk assessment tools have limitations, particularly for younger populations. "Regardless of the tool I use, if you're under 40 [years old], you're low risk. It just doesn't matter. You can plug in the worst numbers for every risk factor, and they will still be low risk," Gulati observed, highlighting the need for more personalized risk assessment approaches.

Practical Implementation of Lifestyle Interventions

Exercise Prescription Challenges

While patients generally understand the importance of healthy lifestyle choices, implementation remains challenging. Gulati questioned whether clinicians are adequately equipped to prescribe lifestyle changes effectively: "We might be able to say things like, 'Eat less, move more,' but are we as good at prescribing it?"

The experts advocated for incremental approaches to exercise prescription. Rather than overwhelming patients with recommendations for 150 minutes of weekly exercise, they suggested starting with just 5 minutes daily and building gradually. Bailey emphasized the population health impact of this approach: "If we can get that group of people who do zero minutes of activity [to do] 10 [minutes of] activity, we probably would make way more [progress] to our goal of preventing disease than getting people going from 20 to 30 [minutes], or 30 to 50 [minutes], or 50 to 75 [minutes]."

Insurance Coverage and Resource Access

Insurance coverage for preventive interventions remains inconsistent. While cardiac rehabilitation may be covered for patients with established cardiovascular disease (搜索)搜索该疾病 who meet specific criteria, coverage for primary prevention services like exercise physiologists and nutritionists is more limited.

Gulati suggested that patients proactively contact their insurers to inquire about wellness coverage, noting that more options exist than previously available. Wong expressed hope that legislation could expand medical nutrition therapy coverage beyond its current limitation to primarily diabetes (搜索)搜索该疾病 patients.

Health savings accounts may cover gym memberships and personal trainers, and Bailey recommended greater utilization of health apps for activity tracking and accountability. The key principle, according to Bailey, is that "optimal should never, ever be the opposite of what is achievable and what we can do today."

Future Directions

The discussion highlighted the evolution of preventive cardiology toward a more comprehensive, team-based approach that addresses the interconnected nature of cardiovascular, kidney, and metabolic health. As Viet Le, PA-C, associate professor of research at Intermountain Health (搜索)搜索该词条 and webinar moderator, noted, cardiovascular disease (搜索)搜索该疾病 has a "long fuse," making it challenging for patients to understand the importance of early lifestyle changes when risks seem distant.

The development of new therapeutic options targeting cardiovascular-kidney-metabolic risk, combined with improved risk assessment tools and more accessible preventive interventions, offers promise for addressing the persistent gaps in cardiovascular disease (搜索)搜索该疾病 prevention. However, success will require continued efforts to overcome barriers related to healthcare access, insurance coverage, and practical implementation of evidence-based prevention strategies.