Abstract
We have reached a limit in our ability to reduce the incidence of coronary heart disease (CHD) and cardiovascular disease (CVD) utilizing the traditional evaluation, prevention, and treatment strategies for the top 5 cardiovascular risk factors - hypertension, diabetes mellitus, dyslipidemia, obesity and smoking. Statistics show that approximately 50% of patients continue to have CHD or myocardial infarction (MI) despite “normal” levels of these five risk factors as traditionally defined. An understanding of the other 395 other CHD risk factors, as well as a more logical and in depth review of these top five risk factors are required. Within the top 5 CHD risk factors the items that should be included are 24 hour ambulatory blood pressure monitoring, advanced lipid profile testing, dysglycemic parameter measurements, visceral obesity evaluation with effects of adipokines and inclusion of lab tests to evaluate the three finite vascular endothelial responses including inflammation, oxidative stress and immune vascular dysfunction. An understanding of translational cardiovascular medicine to correlate the CHD risk factors to the presence or absence of vascular injury and disease with non - invasive vascular testing will allow for early identification, prevention and treatment of CHD and CVD.
Highlights
Cardiovascular medicine needs a complete re-evaluation as to diagnosis, prevention and integrative treatments
The ability to measure these finite responses allows early detection with aggressive management that addresses the initial vascular insult that results in the subclinical or clinical cardiovascular disease (CVD). Treatment of these finite responses with proper nutrition, nutraceutical supplements, exercise, weight control, stress reduction integrated with optimal pharmacological therapies would allow for a more direct pathophysiological analysis and treatment that are cost effective in reducing CVD
The toll-like receptors (TLR) and nod-like receptors (NLR) are membrane receptors that react to external insults with appropriate intracellular signaling that usually induces inflammation, oxidative stress and immune dysfunction within the cell
Summary
Associate Clinical Professor of Medicine, Vanderbilt University School of Medicine Director, Hypertension Institute and Vascular Biology, Saint Thomas Hospital, Nashville, Tennessee, Hypertension Institute, 4230 Harding Road, Suite 400, Nashville, TN 37205, USA
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