PREVENTing Heart Disease

One of our top priorities in Family Medicine is working alongside our patients to prevent disease where we can. This may look like encouraging them to get their screening colonoscopies and end bad habits like smoking, or counseling them about getting a yearly flu vaccine. Sometimes, we have tools to identify patients at increased risk of developing a particular condition, and we can intervene early to alter the course of their health. One area significantly affected by early preventive care is cardiovascular disease.

Cardiovascular disease (CVD) is the leading cause of death in the U.S., so we all must have at least a basic understanding of the risk factors we can control that lead to this condition, so that we can make necessary changes to try to avoid its consequences. The term cardiovascular disease (CVD) includes several conditions of the heart and blood vessels that people may be born with or develop over time. Atherosclerotic cardiovascular disease (ASCVD) is a subgroup of CVD characterized by the accumulation of plaque in arteries, which reduces blood flow and leads to arterial hardening. These arterial changes can occur throughout the body; however, when they affect the arteries supplying blood to the heart, brain, or limbs, a person is at increased risk of heart attack, stroke, or limb loss, respectively.

Over the years, as I have practiced, our approach to counseling patients about ASCVD prevention and to discussing basic laboratory results has evolved as our knowledge of this condition has increased. One of the newest tools we have is from the American Heart Association, and it is called the PREVENT (Predicting Risk of Cardiovascular Disease EVENTs) equation. The purpose of this equation is for use in the primary prevention of CVD, meaning it is useful when we are trying to prevent CVD before it occurs, not to be used for people who already know they have this condition. It is available online for anyone to use, but there are some limitations to the tool. This tool is intended for adults ages 30-79 without known CVD, highly suspected existing CVD, end-stage kidney disease, limited life expectancy, or a known genetic mutation that causes CVD.

We know that there are links between high blood pressure, obesity, diabetes, high cholesterol, and smoking with the development of ASCVD. We have been using ASCVD risk calculators during office visits for years, in which we enter a patient’s specific measurements to generate a computer-generated estimate of their 10-year risk of a cardiovascular event. The PREVENT equation also does this, but it is expanded to include a marker of kidney disease (urine albumin-to-creatinine ratio), an average blood glucose (hemoglobin A1c), and a social deprivation index (by zip code) to provide a more detailed and personalized assessment.

One of the typical situations I face in the office is that a patient comes into their yearly physical and is concerned after they see their lab results online, and the cholesterol results are flagged red and abnormal. This is an opportunity to discuss how their medical history and other risk factors may contribute to the development of ASCVD. Just because an individual’s cholesterol numbers are out of the normal range doesn’t mean that they need to be diagnosed with hyperlipidemia and put on cholesterol-lowering medication. For example, a 25-year-old male, nonsmoker, with normal blood pressure, BMI, and blood sugar may be perfectly healthy with an LDL (often called “bad cholesterol”) of 135, while a 65-year-old male smoker with elevated blood pressure and obesity would need to be counseled about going on a cholesterol-lowering medication to reduce his ASCVD risk. The 65-year-old has lifestyle and medical factors other than just high LDL that put him at risk for developing ASCVD. We would illustrate this distinction by using a tool like the PREVENT calculator.

Patients need to understand is that to prevent ASCVD, it’s not just the lipid numbers that matter-- it’s the comprehensive, big-picture of all their combined health and lifestyle risk factors that would drive the decision to go on risk-lowering medications such as statins. This is why it’s important to schedule your annual physical appointment with your physician, discuss whether it’s time for laboratory testing, and then participate in the discussion of your personal risk of developing ASCVD. If you qualify as a candidate for the PREVENT calculation, it’s reassuring to have a result of a 10-year risk of less than five percent. If your result is above five percent, that’s a great opportunity to discuss with your doctor the lifestyle changes you can make to reduce this risk and whether you should have further testing or consider initiating a prescription medication.

It can be hard to make the changes necessary to protect your heart and improve your health. There are plenty of reliable, effective resources available to help you reduce your risk of heart disease. Make sure to speak with your doctor and check out the resources below!

Resources

The Florida Health Care Plans FHCP Diabetes/Health Education department offers classes and one-on-one sessions with certified experts on a variety of heart health topics. For more information about the program, including how to utilize services, call the FHCP Diabetes/Health Education Department at 386-676-7133

Checkout the American Heart Association PREVENT Online Calculator for more information.

About Florida Health Care Plans

Founded in 1974, Florida Health Care Plans (FHCP) is a pioneering provider of health insurance plans and comprehensive health care services, available to individuals, families, employers, and Medicare-eligible individuals.

Headquartered in Daytona Beach, FHCP was the first federally qualified Health Maintenance Organization (HMO) in Florida and the second federally qualified HMO in the Nation. As a community-based health care provider, FHCP offers members access to primary and multispecialty care, on-site pharmacies and labs, radiology, ultrasound, and other services at its integrated care centers located throughout Brevard, Flagler, St. Johns, Seminole, and Volusia Counties.

An affiliate of Florida Blue and part of the GuideWell family of health solutions companies, FHCP carries an A+ (Superior) Financial Strength Rating from AM Best. FHCP is an independent licensee of the Blue Cross Blue Shield Association.

For additional information, visit www.FHCP.com. For the latest news and content, visit the FHCP Newsroom and follow FHCP on Facebook, LinkedIn, Instagram @floridahealthcareplans, and X (formerly Twitter) @myFHCP.