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Doctors Chided for Neglecting Heart Risk

Readily available tools ignored, heart association president says

MONDAY, Dec. 16, 2002 (HealthDayNews) -- The president of the American Heart Association has a message for physicians:

You're not doing a good enough job of using existing tools that can help you single out people at high risk of cardiovascular disease and treat them appropriately.

The message is delivered in an editorial in tomorrow's edition of Circulation. The issue is devoted to printing a report on those tools, listed in the National Cholesterol Education Program's Adult Treatment III Final Report.

Despite its name, the report is not limited to cholesterol as a risk factor for cardiovascular disease. It also discusses other major contributors -- high blood pressure, high blood triglycerides and obesity. A combination of all of these factors can place a person at high risk of heart disease, even if no single one reaches a dangerous level.

"Although the formulas have been out there for a while, very few physicians are using them to calculate them," says Dr. Robert O. Bonow, a professor of medicine at Northwestern University School of Medicine and president of the heart association.

"A lot of people have a considerable risk of bad events occurring, even though no one major risk factor is extremely elevated. They have multiple elevations that together put them at risk," he says.

A useful assessment tool for overall risk of cardiovascular disease has been developed using data from the Framingham Heart Study, Bonow says. It calculates the 10-year risk of heart disease for men and women on the basis of age, total cholesterol, high density cholesterol (the "good" kind that does not clot arteries), blood pressure and cigarette smoking.

"Although the simple tool is readily available on pocket-sized nomograms or can be downloaded onto a handheld PDA (personal digital assistant), and takes only 30 seconds to use, many primary-care physicians and subspecialists have yet to integrate it into their practice," the editorial says.

Worse, Bonow says, "even some specialists are sometimes not using this kind of approach. If they are not doing it, a lot of primary-care physicians are not doing it."

It's not possible to calculate how many lives would be saved, but the potential is considerable, since cardiovascular disease is the leading cause of death in the United States. Nearly 960,000 Americans die each year of heart disease and stroke, Bonow says.

"Using this tool can enable a physician to determine which people are at low risk and to stratify other people very well to determine how aggressively they should be treated," Bonow says.

The rules for calculating cardiovascular disease also can be used by anyone to adopt a better lifestyle, he says. Among the recommended features are reducing intake of saturated fats to less than 7 percent of total calories, limiting dietary cholesterol to no more than 200 milligrams a day, increasing intake of fruits and vegetables, avoiding obesity and exercising regularly.

One problem is that American medicine focuses too much on treating disease, rather than preventing it, Bonow says.

"We do a great job of treating patients with cardiovascular disease; now we need to do a better job of preventing it," he writes.

What To Do

Learn more about the risk factors for cardiovascular disease from the American Heart Association.

Heart disease is the leading cause of death among American women. The heart association has information on how women can protect themselves.

SOURCES: Robert O. Bonow, professor, medicine, Northwestern University School of Medicine, Chicago, and president, American Heart Association; Dec. 17, 2002, Circulation
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