Barbra Streisand Women's Heart Center (Dr Gulati), Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Ciccarone Center for the Prevention of Cardiovascular Disease (Dr Michos), Johns Hopkins University, Baltimore, MD, USA.
J Clin Lipidol. 2024 Jan-Feb;18(1):e10-e20. doi: 10.1016/j.jacl.2023.12.004. Epub 2023 Dec 15.
It's a privilege to discuss preventive cardiology with 3 of the foremost U.S. leaders in this growing subspecialty. Preventive cardiology is the practice of primordial, primary, and secondary prevention of cardiovascular disease. It employs an integrated team of clinicians committed to preventing all forms of cardiovascular disease, including ischemic heart disease, heart failure, atrial fibrillation, and other conditions. Thus, contemporary preventive cardiology extends management beyond dyslipidemic risk reduction and now commonly includes treatment of hypertension, diabetes and other related cardiometabolic disorders, novel cardiovascular risk factors, thrombotic risk, some cardiac genetic disorders, and cardiac disorders specific to women's health, as well as attention to tobacco- and drug-related risks. Preventive cardiologists may simultaneously manage cardiac rehabilitation programs. Among significant innovations are the launch of the American Journal of Preventive Cardiology in 2020, increasing validation and use of coronary artery calcium scoring, prescription of obesity and diabetes pharmaceuticals by cardiologists, and focus on pregnancy as a natural cardiovascular stress test for women with implications for future cardiovascular events. A continuing major barrier is that reimbursement for preventive cardiology services currently does not match the value benefit which accrues to patients and society. Preventive care too often is added late in the course of disease management. In addition to ongoing pharmaceutical and lifestyle research, future directions include incorporation of specific training goals for preventive cardiology in general clinical cardiology training programs and support for registered dietitian reimbursement for services to patients with clinically manifest atherosclerosis.
与美国预防心脏病学领域的 3 位领军人物讨论预防心脏病学是一种荣幸。预防心脏病学是对心血管疾病进行原始、初级和二级预防的实践。它采用由临床医生组成的综合团队，致力于预防所有形式的心血管疾病，包括缺血性心脏病、心力衰竭、心房颤动和其他疾病。因此，当代预防心脏病学的管理范围超出了降低血脂异常风险，现在通常包括治疗高血压、糖尿病和其他相关的心血管代谢疾病、新的心血管风险因素、血栓形成风险、一些心脏遗传疾病以及特定于女性健康的心脏疾病，以及关注与烟草和药物相关的风险。预防心脏病专家可能同时管理心脏康复计划。其中一些重要的创新包括 2020 年美国预防心脏病学杂志的推出、冠状动脉钙评分的验证和使用不断增加、心脏病专家开处肥胖症和糖尿病药物、以及关注怀孕作为女性自然心血管应激试验，对未来心血管事件有影响。一个持续存在的主要障碍是，预防心脏病学服务的报销目前与为患者和社会带来的价值收益不匹配。预防保健往往是在疾病管理的后期才被添加进来。除了正在进行的药物和生活方式研究外，未来的方向还包括将预防心脏病学的具体培训目标纳入一般临床心脏病学培训计划中，并支持注册营养师为有临床明显动脉粥样硬化的患者提供服务的报销。
