Cardiovascular Disease Update

Cardiovascular disease remains the leading cause of death in the United States,¹ and this edition of FP Essentials provides updates on this critical topic. Section 1 covers peripheral artery disease. Section 2 addresses coronary artery disease risk assessment and noninvasive testing. Section 3 is about medical management of chronic coronary disease. Section 4 provides an update on heart failure. In all four sections, common themes are presented. Lifestyle interventions are key to prevention and management, including regular exercise, healthy eating, not smoking, and maintaining optimal ranges for blood pressure, cholesterol, blood glucose, and weight. Some approaches to pharmacotherapy have been around for years, whereas others are relatively new. I hope you find this edition of FP Essentials helpful in your practice. When you have finished studying and are ready to submit your answers to the test questions, please let us know what was most useful and what we can do to improve. We look forward to hearing your ideas for topics you would like to see covered in future editions.

Karl T. Rew, MD, Associate Medical Editor
Clinical Associate Professor, Departments of Family Medicine and Urology
University of Michigan Medical School, Ann Arbor

Dustin K. Smith, DO, FAAFP, is the program director of the Jacksonville Family Medicine Residency Program at Naval Hospital Jacksonville in Florida. He is an associate professor of family medicine at the Uniformed Services University of the Health Sciences in Bethesda, Maryland. Dr. Smith’s research interests include cardiovascular disease, hypertension, and pediatric infectious diseases.

Anthony M. Recidoro, DO, FAAFP, is an associate program director at Camp Pendleton Family Medicine Residency Program and an assistant professor of family medicine at the Uniformed Services University of the Health Sciences. He completed a fellowship in faculty development through the University of North Carolina Family Medicine Residency in Chapel Hill. Dr. Recidoro’s research interests include point-of-care ultrasonography, medical student education, and health excellence.

Joseph M. Sapoval, DO, is a graduate medical education faculty member in the Jacksonville Family Medicine Residency Program at Naval Hospital Jacksonville and an assistant professor of family medicine at the Uniformed Services University of the Health Sciences. Dr. Sapoval’s research interests include preventive cardiology, sports medicine, and osteopathic manipulation.

Kevin A. Bobeck, MD, is a cardiology fellow at Walter Reed National Military Medical Center in Bethesda, Maryland. He is an assistant professor of medicine at the Uniformed Services University of the Health Sciences. Dr. Bobeck’s research interests include electrophysiology, especially in tactical athletes.

Disclosure: It is the policy of the AAFP that all individuals in a position to control CME content disclose any relationships with ineligible companies upon nomination/invitation of participation. Disclosure documents are reviewed for potential relevant financial relationships. If relevant financial relationships are identified, mitigation strategies are agreed to prior to confirmation of participation. Only those participants who had no relevant financial relationships or who agreed to an identified mitigation process prior to their participation were involved in this CME activity. All individuals in a position to control content for this activity have indicated they have no relevant financial relationships to disclose.

• Interpret results of ankle-brachial index testing.
• Prescribe appropriate evidence-based interventions for patients with peripheral artery disease.
• Use a pooled cohort equation to estimate cardiovascular risk in patients 40 to 75 years of age.
• Consider using lipoprotein(a) to help further stratify risk in those with a strong family history of early major adverse cardiovascular events.
• Manage chronic coronary disease using guideline-directed medical therapy.
• Refer appropriate patients to exercise-based cardiac rehabilitation therapy.
• Identify the types of heart failure and understand the commonly used classifications and stages.
• Implement pharmacologic and nonpharmacologic strategies for patients with heart failure to reduce disease progression, minimize hospitalizations, and improve survival.