Addressing Cardiovascular Risk and Intervening Early—Recording

Cardiovascular disease remains the leading cause of mortality in the US, and despite years of encouraging progress, there remains an urgent need for a focus on prevention.

Viet Le, PA-C, Intermountain Health

In a recent webinar from The American Journal of Managed Care® (AJMC®) in coordination with the American Society for Preventive Cardiology (ASPC), Viet Le, PA-C, associate professor of research at Intermountain Health, moderated a discussion on cardiovascular risk and prevention with the following panelists:

• Alison Bailey, MD, FACC, FASPC, chief of cardiology at Centennial Heart and a physician director of cardiovascular disease for HCA Healthcare
• Martha Gulati, MD, MS, FACC, FAHA, FASPC, FESC, cardiologist at the Cedars-Sinai Medical Center Schmidt Heart Institute, professor of cardiology and associate director of the Barbra Streisand Women’s Heart Center, and director of cardiovascular disease prevention
• Nathan Wong, PhD, MPH, FACC, FAHA, FNLA, FASPC, professor and director of the Heart Disease Prevention Program at the Mary & Steve Wen Cardiovascular Division and codirector of the Center for Global Cardiometabolic Health and Nutrition at University of California, Irvine

Martha Gulati, MD, MS, FACC, FAHA, FASPC, FESC, Cedars-Sinai Medical Center

The discussion emphasized the need for personalized risk assessments, including coronary calcium scores and uric acid levels, and highlighted strategies for lifestyle changes, such as structured exercise and dietary modifications.

Gulati and Le started the discussion by explaining the developing understanding of cardiovascular kidney metabolic health as a foundation of general or preventive cardiology.

“I think the interconnectedness is what we have appreciated for some time,” Gulati said. “But I think what is exciting is that not just are we talking about it, but there [are] drugs being developed that are changing the cardiovascular and cardiometabolic kidney risk, which we did not have before.”

Alison Bailey, MD, FACC, FASPC, of Centennial Heart

Bailey outlined some of the barriers that play a role in the prevention of cardiovascular diseases, starting with inaction until after an event takes place. Cardiologists may not meet with a patient until after they have been dealing with uncontrolled lipids or hypertension for 2 decades. The second barrier is the lack of access to care.

“We know there's a rural health crisis, and our patients who live in rural areas don't have physical access to care,” Bailey said. “They may not have physicians or care teams that they can go see, but we also have a lack of insurance or underinsured status, and so both of those are big barriers when we're thinking about a lifetime chronic disease.”

Nathan Wong, PhD, MPH, FACC, FAHA, FNLA, FASPC, of University of California, Irvine

Looking at risk factors for cardiovascular disease, Wong discussed the role of lipoprotein(a) (Lp[a]), which has become a hot topic in the preventive cardiovascular space in recent years. Lp(a) is highly atherogenic, meaning it contributes to the development of atherosclerosis and cardiovascular disease, and it is 6 times more atherogenic than low-density lipoprotein (LDL). Even if LDL is well controlled, the presence of Lp(a) will further add to residual risk, he explained.

“Recent data show that fewer than 1% of patients actually get Lp(a) tested,” Wong said. “So, we really have a long ways to go to increase awareness.” However, he pointed to new recommendations from the National Lipid Association that call for adults to get tested for Lp(a) at least once in their life.

The panelists discussed other emerging risk factors, how to personalize risk assessments, and how to address risk and start treating patients when they’ve been identified as having a high risk.

For more around preventive cardiology, stay tuned for AJMC’s coverage of the ASPC 2025 Congress on CVD Prevention, taking place August 1-3, in Boston, Massachusetts.