This second edition guide is a single resource that provides information on multiple national guidelines, recommended treatment goals that pertain to both primary and secondary prevention of cardiovascular disease (CVD), and information on compliance strategies for enhancement of risk factor reduction interventions. More specifically, the Pocket Guide includes information and guidelines on cardiovascular risk assessment and prevention, lifestyle interventions, cholesterol, hypertension, obesity/weight loss, diabetes and smoking cessation. This publication is included in PCNA new member packets.

Objectives include: Discuss the anatomy and control of normal blood flow to the heart; define the role of atherosclerosis in causing coronary artery disease (CAD); identify the signs, symptoms, laboratory values, and clinical images of coronary artery disease and summarize prevention measures for CAD.

October 2007 issue of The CME

The American Heart Association scientific statement on the treatment of hypertension in the prevention and management of ischemic heart disease was published recently. The main recommendations were as follows: (1) For most adults with hypertension, the blood pressure (BP) goal is <140/90 mm Hg but should be <130/90 mm Hg in patients with diabetes mellitus, chronic kidney disease, known coronary artery disease (CAD), CAD equivalents (carotid artery disease, abdominal aortic aneurism, and peripheral vascular disease), or 10-year Framingham risk score of ≥10%. For those with left ventricular dysfunction, the recommended BP target is <120/80 mm Hg. (2) For primary CAD prevention, any effective antihypertensive drug or combination is indicated, but preference is given to angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), calcium channel blockers (CCBs), and thiazide diuretics. (3) For the management of hypertension in patients with established CAD (stable or unstable angina, non–ST-segment elevation myocardial infarction, ST-segment elevation myocardial infarction), β-blockers and ACE inhibitors (or ARBs) are the basis of treatment. If further BP lowering is needed, a thiazide diuretic and/or a dihydropyridine CCB (not verapamil or diltiazem) can be added. If a β-blocker is contraindicated or not tolerated, diltiazem or verapamil can be substituted. (4) If there is left ventricular dysfunction, recommended therapy consists of an ACE inhibitor or ARB, a β-blocker, and either a thiazide or loop diuretic. In patients with more severe heart failure, an aldosterone antagonist and hydralazine/isosorbide dinitrate (in black patients) should be considered. (J Clin Hypertens. 2007;9:790–795) ©2007 Le Jacq

Live seminar offered at 5 locations.

Delayed diagnosis of cardiovascular disease is the most common area of malpractice suits for primary care. Your patient population is aging and you need to rule out or manage coronary artery disease on a daily basis. This CME medical conference covers the basics for cardiac exercise testing (ET), including indications, contraindications, limitations, alternatives, equipment and personnel needs. Whether you have been doing exercise testing for years or are now considering it for your practice, you will benefit from this CME medical conference.

The Preventive Cardiovascular Nurses Association offers complimentary online continuing educational programs. This course outlines the health benefits of omega-3 fatty acids in general, walnuts in particular, and discusses recommendations for relaying this information to patients.

The Preventive Cardiovascular Nurses Association offers complimentary online continuing educational programs Heart Talk: Nourishing Healthy Hearts in a FREE online program that provides nurses and nurse practitioners with a solid knowledge base in the basic principles of nutrition as they relate to the prevention and treatment of coronary heart disease so that they may be able to apply these principles in the support of heart healthy lifestyle changes in their patients. Read more at Hartford Institute for Geriatric Nursing

Although the use of antiarrhythmic agents is extraordinarily important in ischemic heart disease, therapeutic options for treating ischemia-related arrhythmias are limited. Recently, the late sodium channel inhibitor ranolazine has been shown to have antiarrhythmic properties in addition to antianginal effects. Results of the Metabolic Efficiency With Ranolazine for Less Ischemia in Non-ST-Elevation Acute Coronary Syndromes - Thrombolysis in Myocardial Infarction 36 (MERLIN-TIMI 36) trial showed that treatment with ranolazine significantly reduced ischemia-related arrhythmias, as measured with Holter recording, during the first 7 days after randomization.

This American College of Cardiology/American Heart Association/National Heart, Lung and Blood Institute (ACC/AHA/NHLBI) Clinical Advisory is intended to summarize for professionals the current understanding of statin use, focused on myopathy, and to provide updated recommendations for the appropriate use of statins, including cautions, contraindications, and safety monitoring for statin therapy. Its purpose is not to discourage the appropriate use of statins, which have life-saving potential in properly selected patients, particularly those with established coronary heart disease (CHD) and others at high risk for developing CHD. Included are recent myopathy information compiled by the FDA, information from clinical trials, and summaries from the recently released report of the Adult Treatment Panel III (ATP III) of the National Cholesterol Education Program (NCEP).

This document has been developed as a Clinical Expert Consensus Document (CECD), by the American College of Cardiology Foundation (ACCF) and the American Heart Association (AHA) in collaboration with the Society of Atherosclerosis Imaging and Prevention (SAIP) and Society of Cardiovascular Computed Tomography (SCCT). It is intended to provide a perspective on the current state of the role of coronary artery calcium (CAC) scoring by fast computed tomography in clinical practice. Clinical Expert Consensus Documents are intended to inform practitioners, payers, and other interested parties of the opinion of the ACCF and AHA concerning evolving areas of clinical practice and/or technologies that are widely available or new to the practice community.

The Adult Treatment Panel III (ATP III) of the National Cholesterol Education Program issued an evidence-based set of guidelines on cholesterol management in 2001. Since the publication of ATP III, 5 major clinical trials of statin therapy with clinical end points have been published. The major recommendations for modifications to footnote the ATP III treatment algorithm are presented here.

The Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III, or ATP III) presents the National Cholesterol Education Program’s (NCEP’s) updated recommendations for cholesterol testing and management. This report continues to identify low-density lipoprotein (LDL) as the primary target of cholesterol-lowering therapy.

The ADA and AHA each have published guidelines for CVD prevention that overlap with the present statement: The ADA has issued separate recommendations for each of the cardiovascular risk factors in patients with diabetes, and the AHA has shaped primary and secondary guidelines that extend to patients with diabetes. The present document will attempt to harmonize the recommendations of both organizations where possible but will recognize areas in which ADA and AHA recommendations differ.

Cardiovascular disease (CVD) is frequently associated with CKD, which is important because individuals with CKD are more likely to die of CVD than to develop kidney failure, CVD in CKD is treatable and potentially preventable, and CKD appears to be a risk factor for CVD. In 1998, the National Kidney Foundation (NKF) Task Force on Cardiovascular Disease in Chronic Renal Disease issued a report emphasizing the high risk of CVD in CKD. This report showed that there was a high prevalence of CVD in CKD and that mortality due to CVD was 10 to 30 times higher in dialysis patients than in the general population. The task force recommended that patients with CKD be considered in the "highest risk group" for subsequent CVD events and that treatment recommendations based on CVD risk stratification should take into account the highest-risk status of patients with CKD.

Given the marked increase in short- and long-term mortality associated with hyperglycemia, there is an urgent need for definitive large randomized trials to determine whether treatment strategies aimed at glucose control will improve patient outcomes and to define specific glucose treatment targets. Although firm guidelines will need to await completion of these clinical trials, the present statement also provides consensus recommendations for hyperglycemia management in patients with ACS on the basis of the available data.

This statement seeks to consider the best available evidence for an association between inflammatory markers and cardiovascular disease. In this consideration, the U.S. Surgeon General’s criteria for inference of causality were used in examination of the evidence, namely the strength, temporality, dose-response relationship, biological plausibility, and consistency of the evidence were reviewed. The quality of scientific evidence for an association was assessed (2) and the American College of Cardiology/American Heart Association classification of recommendations and levels of evidence were used (see Appendix 1). Moreover, the use of inflammatory markers as screening tools also employed an evidence-based approach (3). This included evidence from properly designed randomized trials that intervention in screening-positive persons benefited them, as well as a consideration of the potential benefits, harm, differences in performance between different groups of people, use in various screening strategies, and cost effectiveness.

This scientific statement reviews the scientific data for cardiac computed tomography (CT) related to imaging of coronary artery disease (CAD) and atherosclerosis. In this statement, the American Heart Association (AHA) Writing Group evaluates the available data for the application of cardiac CT for CAD.

This statement from the American Heart Association (AHA) and the National Heart, Lung, and Blood Institute (NHLBI) is intended to provide up-to-date guidance for professionals on the diagnosis and management of the metabolic syndrome in adults.

Given the marked increase in short- and long-term mortality associated with hyperglycemia, there is an urgent need for definitive large randomized trials to determine whether treatment strategies aimed at glucose control will improve patient outcomes and to define specific glucose treatment targets. Although firm guidelines will need to await completion of these clinical trials, the present statement also provides consensus recommendations for hyperglycemia management in patients with ACS on the basis of the available data.