PRIMARY PREVENTION. The goal of primary prevention is the evaluation of risk factors for atherosclerosis and the development of a prevention strategy for a patient without established Coronary Artery Disease. The evaluation of risk allows for placement of a patient into one of three categories: Low Risk, Intermediate Risk, and High Risk.
The intensity of the risk factor management can then be adjusted based on the severity of the risk, to include drug therapy where clinical judgement deems that to be appropriate. Intervention is recommended when any causative risk factor reaches a certain categorical level. Those categorical levels would be:
-Cigarette Smoking: any current smoking.
-Blood Pressure: greater than 140/90.
-Elevated LDL Cholesterol: greater than 160.
-Low LDL Cholesterol: less than 35.
-Diabetes: blood sugar greater than 126.
The gist of treatment recommendations for low risk patients would be for them to observe healthy dietary, behavioral, and lifestyle choices, which will be outlined in our treatment section. Similar advice is given for patients at high risk, but they also enter into a more aggressive treatment plan to include drug therapy where needed. Patients at intermediate risk are advised to consider testing aimed at evaluating the presence of atherosclerosis through non-invasive means. This is intended to further evaluate their risk, which then allows treatment advice.
The therapeutic regimens will be detailed in our section regarding treatment.
Secondary prevention is the treatment of patients with established cardiovascular disease and those who have had a cardiovascular event (such as a heart attack) or a stroke. The goal is to prevent or slow the development of, and in some cases to reverse, the changes of atherosclerosis, and to prevent another heart attack or stroke. Comprehensive risk factor interventions in such patients have been shown to extend overall survival, improve the quality of life, decrease the need for interventional procedures such as bypass, and to decrease the chance of another heart attack.