Comprehensive Management of High Risk Cardiovascular Patients PDF

Preface

In the new millennium, physicians worldwide face many new challenges. The past five decades have yielded extraordinary advances in the identification and management of a wide array of cardiovascular diseases. This work has sharply impacted average life expectancy for men and women and improved outcomes following disease onset. Considerable basic scientific and clinical research has revealed an extraordinarily detailed view of many of the most intimate biochemical and pathophysiologic mechanisms regulating cardiovascular disease. Despite the development of numerous pharmacologic and surgical interventions, cardiovascular disease remains the leading cause of death and disability in industrialized nations.

Many of the most important genetic backgrounds and risk factors for the development of cardiovascular disease have been well characterized in epidemiologic and clinical studies conducted throughout the world. Dyslipidemia, hypertension, obesity, insulin resistance, diabetes mellitus, and cigarette smoking are among the most important of these risk factors. The incidence of all these risk factors continues to increase and reach epidemic proportions throughout much of the world. As additional societies become progressively more industrialized and as the world population continues to grow older and more obese, the number of people affected clinically by the ravages of atherosclerotic disease will continue to rise. Much basic work using animal models and the completion of numerous human clinical trials have revealed much about the management of heart failure, cardiac arrhythmias, chronic kidney disease, noncoronary atherosclerotic disease, pulmonary hypertension, and stroke, among other clinical entities. Perhaps even more important than disease management is the increasing pressure on clinicians to identify risk factors for cardiovascular disease early and to intervene aggressively. Such measures are requisite to stemming the rising human and economic cost of cardiovascular disease.

This book is intended to help fill a large gap in the management of patients who have, or are at risk of developing, cardiovascular disease. Rather than being encyclopedic in scope, it is designed to serve as a resource for the busy, practicing clinician. The approach is evidence-based but practical. Conceptual development and the exploration of biochemical and physiological mechanisms are balanced by focused attention on the everyday issues of caring for patients with specific metabolic and cardiovascular disorders. Standards of care and challenging management issues are illustrated and reinforced by case studies. Pharmacotherapeutic choices are discussed in light of findings from clinical trials. Elements of care unique to women and people of different racial and ethnic groups are explored in detail. Lifestyle modifications and the risks and benefits of specific therapies are addressed. Comprehensive care in both primary and secondary prevention settings is stressed. Moreover, effort is made to remove the reluctance on the part of primary care providers to treat such disorders as atherosclerotic disease, congestive heart failure, severe hypertension, complex dyslipidemias, and chronic renal disease, among others.

It is our sincerest hope that this book will help ensure that the many lessons and the most important research findings of recent years will be more aptly and regularly applied to patients day in and day out, one precious life at a time.