Risk Factor Modification

Cardiovascular risk factor modification is an essential component in the management of all patients with vascular disease to minimize their risk for disease recurrence. Despite the performance of both surgical and percutaneous interventions for the acute treatment of vascular disease, the cornerstone of treatment for these patients remains optimization of medical therapies directed against risk factors for this disease.

Although recommendations for the medical treatment of cardiovascular disease are well formulated, the underutilization of such therapies is well documented. By some estimates, only one third of patients with vascular disease are treated according to AHA/ACC Guidelines. Clearly there is considerable room for improvement.

Our cardiovascular patients are ideal candidates for the implementation and reinforcement of these guidelines. Adherence of specific guidelines will have a considerable impact on the long-term prognosis of our patients. Because published compliance rates are so very low, specific attention to these guidelines will help long-term reduction in the recurrence of these diseases.

AHA/ACC Guidelines for secondary prevention and long-term goals include:

Antithrombotics: ASA 75 to 325 mg/day
                             Warfarin INR 2.0 – 3.0
Beta Blockers: Indefinitely for post-MI and ischemic syndrome patients
ACE Inhibitors: Indefinitely for post MI and CHF patients; consider for all vascular                patients
Lipids: Low Density Lipoprotein < 100
Diabetes: Hemaglobin A1c <7%
Hypertension: Blood Pressure (mm Hg)
     <140/90 for most patients
     <130/85 for CHF or renal failure patients
     <130/80 for diabetes
Smoking: complete cessation
Physical Activity: 30min 3-4 times per week
Weight Management: 18.5<BMI<24.9

It is planned that drug therapy for the first five parameters will be started and counseling for the last three parameters will be reinforced during the hospitalization. Close adherence to these guidelines as an outpatient will be necessary over the long term to reduce the longterm impact of cardiovascular disease in our patients. We look forward to partnering with you in this endeavor as we attempt to provide our patients with optimization of their risk factor management.