Stay Ahead of Heart Disease with Preventive Cardiology
What is preventive cardiology?
Heart and vascular disease is the leading cause of death for men and women in America. In fact, about one in every four deaths in the United States can be attributed to heart disease. Advanced heart disease can often result in a heart attack or stroke.
Preventive cardiology is a subspecialty of medicine that focuses on lowering the risk of heart disease before a diagnosis or incident, or—for patients who have had a first heart attack or stroke—reducing the chance of having another event.
“A preventive cardiologist’s main goal is to prevent the onset or worsening of heart disease by reducing a patient’s risk factors. In doing so, preventive cardiologists can also help prevent the need for invasive cardiovascular procedures, such as cardiac bypass or coronary stenting,” says Jorge Plutzky, MD, the Director of Preventive Cardiology in the Division of Cardiovascular Medicine at Brigham Health.
For patients with heart disease or those at risk, the Preventive Cardiology Program at Brigham Health provides comprehensive care and access to world-class cardiologists, cutting-edge treatments, and integrated clinical programs aimed at reducing cardiovascular risk factors and staying healthy.
Who Should See a Preventive Cardiologist?
Certain lifestyle choices and medical conditions can increase the risk of heart disease. Cardiovascular risk factors are categorized as either “established” or “emerging.”
Established risk factors have strong evidence that they contribute to the future risk of a heart attack and stroke. For many of these risk factors, evidence also exists that treating these factors reduces the risk of a future event.
“A classic example of an established risk factor is cigarette smoking,” says Dr. Plutzky. “We know that smoking increases risk of heart disease, and we know that if you stop smoking, your risk goes down.”
Additional established risk factors include:
- High blood pressure
- High cholesterol (especially high low-density lipoprotein, or LDL, colloquially known as ‘bad cholesterol’)
- Lifestyle choices (especially an unhealthy diet and lack of exercise)
There are some established risk factors that are currently untreatable but emerging research is revealing potential ways to treat these conditions. They include:
- Family history of heart disease and/or early heart attack or stroke
- Specific genetic disorders
Emerging risk factors are factors that studies have suggested may contribute to cardiovascular risk but lack definitive evidence that this is the case, or that treating those parameters will reduce the risk.
Lipoprotein(a) is an example of an emerging risk factor that demands more research. Inflammation used to be an emerging risk factor, but recent research has made it an established risk factor.
“Elevated levels of inflammation, measured as high C-reactive protein, or high CRP, has been shown to increase the risk of cardiovascular disease, while lowering inflammation decreases this risk,” explains Dr. Plutzky.
When Should I See a Preventive Cardiologist?
Most patients who come to Brigham Health’s Preventive Cardiology Program have been referred by their primary care provider, internist, or another cardiologist.
Reasons for referral may include:
- Bloodwork that shows abnormally high or low levels of LDL, high-density lipoprotein (HDL), or triglycerides
- A pre-existing heart condition
- A strong family history of early onset heart disease
- Statin intolerance
“About 30 to 50 percent of patients are referred to preventive cardiology because they experience statin intolerance. Often, a preventative cardiologist can help resolve this issue or find another treatment approach,” says Dr. Plutzky.
It’s important to be aware of risk factors at any age. In fact, a rise in childhood obesity and diabetes has made preventive cardiology an important service for younger people.
The Preventive Cardiology Program has a strong relationship with Boston Children’s Hospital and refers high-risk patients under 18 years of age to Boston Children’s to assist with lifestyle modification or cholesterol-lowering treatment.
Heart Disease Prevention and Wellness Services at Brigham Health
Brigham Health provides a range of prevention and wellness services for patients with heart disease and those at risk for heart disease.
Multidisciplinary Team Increases Efficiency and Flexibility
Although the Brigham’s Preventive Cardiology team specializes in prevention, all faculty members are trained cardiologists. Depending on a patient’s unique condition, a preventive cardiologist can also serve as a primary cardiologist, allowing for integrated care and fewer hospital visits. Preventive cardiologists can also work with a patient’s referring cardiologist. This flexibility allows for individualized care plans.
Cardiovascular Health Evaluation
Brigham Health’s core preventive cardiology services involves identifying a patient’s highest risk factors and then providing interventions to modify their risk. The first step is to evaluate a patient’s risk profile.
An initial visit to a preventive cardiologist will include an assessment of the following:
- Traditional risk factors: cholesterol/lipid profile, blood pressure, glucose/diabetes, smoking history
- Family history of heart disease
- Lifestyle choices: diet, exercise habits, sleep quality
- Existing medical conditions (e.g., diabetes or prediabetes)
- Blood tests for lipoprotein(a) or C-reactive protein tests for inflammation (only if a heart attack or stroke is difficult to explain)
Cardiac Imaging & Genetic Screening
Advanced cardiac imaging and CT scans are evolving areas in cardiovascular medicine and are used as effective assessment methods. At the Cardiovascular Imaging Program, providers examine a patient’s coronary arteries to predict the future risk of heart disease.
Typically reserved for patients with ambiguous risk factors, cardiac imaging has been especially important for individuals with more complex cardiovascular conditions, such as those with a family history or emerging risk factors.
Some patients can also undergo genetic screening. Genetic screening is recommended for individuals with a strong family history, an early diagnosis, or no obvious explanation by traditional risk factors.
“Most patients won’t need genetic screening, but the service is available for those who require it. Our team uses all the tools available at our disposal to identify the highest areas of risk in our patients,” says Dr. Plutzky.
Lipid and Cholesterol Management
The Preventative Cardiology team can address abnormal levels of cholesterol (LDL or HDL), triglycerides, and/or lipoprotein(a) with a number of therapies that may include:
- Prescription medications
- Over-the-counter agents/vitamins
- Nutritional counseling
- Lifestyle recommendations
“Preventative cardiologists are also well-trained in managing treatment for patients who are intolerant to statin medications,” says Dr. Plutzky.
Cardiac Rehabilitation and Wellness
Recovery from a previous heart attack or bypass surgery often involves participation in Cardiac Rehabilitation, which is directed by Preventive Cardiology. Cardiac Rehab provides supervised exercise sessions that allow patients to increase physical activity and mobility. Patients are also educated about heart disease and how to manage the condition.
Given the strong association between heart disease and diabetes, the Preventive Cardiology program offers an integrated clinic for patients with both conditions. This clinic allows for more efficient care and reduces the number of visits to the hospital.
“Recent studies have revolutionized our treatment of diabetes,” says Dr. Plutzky. “We can offer new agents that lower glucose and reduce the risk of heart disease.”
Collaboration with Brigham’s World-Renowned Rheumatology Division
Emerging research has shown that patients with inflammatory rheumatologic disorders, such as rheumatoid arthritis, may have an increased risk of heart disease.
At the Brigham, the Preventive Cardiology Program and Rheumatology Services established the Cardiovascular Rheumatology Clinic to treat patients who have both conditions using the latest research from clinical trials.
Cutting-edge Clinical Trials, Research, and Innovation
For decades, the Preventive Cardiology Program has participated in countless pioneering clinical trials that investigate risk factors associated with heart disease. Insights and advances from these trials are always being translated into treatments at Brigham Health.
“Our Preventive Cardiology Program leads clinical practice in cardiology,” says Dr. Plutzky. “We bring together the science of understanding the heart disease process; the clinical trial data on what’s been proven and unproven; the clinical experience of different ways to intervene; and teaching patients and clinicians about these advances.”
This unique combination of specialties makes Brigham Health a global leader in preventive cardiology. Through groundbreaking cardiovascular research, these physicians and scientists often have early access to medications via clinical trials. New research and trials, combined with clinical experience, allow for an innovative body of programs.
Recent research at Brigham Health has identified drugs that may lower the risk of heart attack among patients with diabetes. Until recently, while evidence showed that diabetes increased the risk of heart disease, physicians were puzzled to find that treating diabetes didn’t show a decrease of risk. Now, a new diabetes therapy known as SGLT2 inhibitors and GLP1 receptor agonists show promise in decreasing future risk of heart attack.
The Preventive Cardiology Program also works with the Brigham’s Cardiovascular Medicine Innovation to develop remote treatments. “We have developed new programs that incorporates population health screening and treatment algorithms to identify patients who meet indications for receiving better treatment,” says Dr. Plutzky.
This remote cardiovascular health initiative is equipped to manage cholesterol, and similar programs are underway to address hypertension and heart failure from the comfort of a patient’s home.
Taken together, Preventive Cardiology at Brigham Health has been and continues to be a leader in understanding, treating, and educating the public about heart disease and how to prevent it.
To make appointment with a preventative cardiologist, you can request an appointment online or call (857) 307-4000.
— September 13, 2019