Defining preventive cardiology: A clinical practice statement from the American Society for Preventive Cardiology

Charles A German; Seth J Baum; Keith C Ferdinand; Martha Gulati; Tamar S Polonsky; Peter P Toth; Michael D Shapiro

doi:10.1016/j.ajpc.2022.100432

Defining preventive cardiology: A clinical practice statement from the American Society for Preventive Cardiology

Am J Prev Cardiol. 2022 Nov 16:12:100432. doi: 10.1016/j.ajpc.2022.100432. eCollection 2022 Dec.

Authors

Charles A German¹, Seth J Baum², Keith C Ferdinand³, Martha Gulati⁴, Tamar S Polonsky¹, Peter P Toth⁵, Michael D Shapiro⁶

Affiliations

¹ Section of Cardiology, Department of Medicine, University of Chicago, Chicago, IL, USA.
² Department of Integrated Medical Science, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA.
³ Tulane Heart and Vascular Institute, Tulane University School of Medicine, New Orleans, LA, USA.
⁴ Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
⁵ Cicarrone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD and CGH Medical Center, Sterling, IL, USA.
⁶ Section on Cardiovascular Medicine, Center for Prevention of Cardiovascular Disease, Wake Forest University School of Medicine, Winston-Salem, NC, USA.

Abstract

Remarkable transformations in science and healthcare have resulted in declines in mortality from cardiovascular disease over the past several decades, largely driven by progress in prevention and treatment of persons at risk. However, these trends are now beginning to stall, as our county faces increases in cardiovascular risk factors including overweight and obesity, type 2 diabetes mellitus, and metabolic syndrome. Furthermore, poor long-term adherence to a healthy lifestyle and lifesaving pharmacotherapy have exacerbated these trends, with recent data suggesting unprecedented increases in cardiovascular morbidity and mortality. A paradigm shift is needed to improve the cardiovascular health of our nation. Preventive cardiology, a growing subspecialty of cardiovascular medicine, is the practice of primordial, primary, and secondary prevention of all cardiovascular diseases. Preventive cardiologists and preventive cardiology specialists are well equipped with the knowledge and skill-set necessary to reduce deaths related to the growing burden of heart disease and its risk factors. Despite dedicated efforts, cardiovascular disease remains the leading killer of men and women in the United States. Although there is little debate regarding the importance of prevention, many healthcare professionals question the need for preventive cardiology as a distinct subspecialty. Additionally, the field's growth has been hampered by a lack of organization and standardization, and variability of training within programs across the country. The purpose of this document is to delineate the key attributes that define the field of preventive cardiology according to the American Society for Preventive Cardiology.

Keywords: ACC, american college of cardiology; AHA, american heart association; ASPC, american society for preventive cardiology; Atherosclerosis; BMI, body mass index; CAC, coronary artery calcium; CCTA, coronary CT angiography; CMS, centers for medicare and medicaid services; CR, cardiac rehabilitation; CVD, cardiovascular disease; CVH, cardiovascular health; Cardiovascular disease; DHA, docosahexaenoic acid; EPA, eicosapentaenoic acid; FHS, framingham heart study; GLP1-RA, glucagon-like peptide 1 receptor agonists; LDL-C, low-density lipoprotein cholesterol; Mets, metabolic syndrome; NHANES, national health and nutrition examination survey; NIH, national institutes of health; NNT, number needed to treat; OSA, obstructive sleep apnea; PA, physical activity; PAD, peripheral artery disease; PCE, pooled cohort equations; PCSK9, proprotein convertase subtilisin kexin 9; Preventive cardiology; Primary prevention; Primordial prevention; Risk assessment; SES, socioeconomic status; SGLT2i, sodium glucose cotransporter 2 inhibitors; Secondary prevention; T2DM, type 2 diabetes mellitus; US, united states.

Publication types

Review