Cardiovascular risk assessment

TABLE 48-5. Cardiovascular Risk Assessment for Phosphodiesterase Inhibitors... 

In view of Mr HA s age he requires cardiovascular risk assessment. How would you assess this patient s cardiovascular risks ... 

Patients <40 years with a family history of premature atherosclerotic disease should also have their cardiovascular risk assessed. 

Rifai N> Ridker PM. Proposed cardiovascular risk assessment algorithm using high-sensitivity C-reactive protein and lipid screening. Cfin Chem 2001 47 28-30. 

Benzaquen LR, Yu H, et al. High sensitivity C-reactive protein an emerging role in cardiovascular risk assessment. Crit Rev Clin Lab Sci 2002 39 459-97. 

Domanski M, Norman J, Wolz M, et al. Cardiovascular risk assessment using pulse pressure in the first national health and nutrition examination survey (NHANES I). Hypertension 2001 38 793-797. 

Brennan, M-L. and Hazen, S.L. Emerging role of myeloperoxidase and oxidant stress markers in cardiovascular risk assessment. Current Opinion in Lipidology 14, 353-359 (2003). 

Vaduganathan M, Prasad V (2016) Cardiovascular risk assessment in oncological clinical trials is there a role for centralized events adjudication Eur J Heart Fail 18 128-132 Westerhout CM, Bakal JA (2015) Novel approaches to composite endpoints in clinical trials. Eurointervention 11 122-124... 

Guth BD (2007) Preclinical cardiovascular risk assessment in modem drug development. Toxicol Sci 97 4—20... 

Safar ME, Jankowski P (2009) Central blood pressure and hypertensirai role in cardiovascular risk assessment. Clin Sci 116 273-282... 

Our new appreciation of the role of inflammation in atherosclerosis shows the way for translation of these novel biological insights to clinical practice, for example by aiding the identification of individuals at risk of adverse cardiovascular events [5]. In this context, inflammatory biomarkers such as CRP merit rigorous consideration for inclusion in risk assessment strategies. In addition, these scientific advances provide a framework... 

The results of these trials demonstrate that ERT or HRT should not be prescribed for the prevention of CHD or in patients with preexisting CHD. For women suffering from vasomotor symptoms with a history of CHD, including CHD risk factors, alternative therapies should be considered. Additionally, lifestyle modifications should be implemented, and therapies to treat risk factors such as hypertension and hyperlipidemia should be prescribed. It is important to note that the average age of women included in the HERS and the WHI trials was 67 and 63 years, respectively. Therefore, these trials were unable to assess the true risk in younger, potentially healthier women with fewer cardiovascular risk factors. 

A complete history and physical examination should assess (1) presence or absence of cardiovascular risk factors or definite cardiovascular disease in the individual (2) family history of premature cardiovascular disease or lipid disorders (3) presence or absence of secondary causes of hyperlipidemia, including concurrent medications and (4) presence or absence of xanthomas, abdominal pain, or history of pancreatitis, renal or liver disease, peripheral vascular disease, abdominal aortic aneurysm, or cerebral vascular disease (carotid bruits, stroke, or transient ischemic attack). 

Assessment for influenza and pneumococcal vaccine administration and assessment and management of other cardiovascular risk factors (e.g., smoking and antiplatelet therapy) are components of sound preventive medicine strategies. 

Fig. 9.6. Relative risk ( 95% confidence intervals) for any cardiovascular event in the group treated with raloxifene or placebo. The information was obtained from the subgroup of women at increased cardiovascular risk in the MORE study. The overall data seem to favor raloxifene, but this effect is clearer when women were grouped according to their risk as assessed by the previously defined severity score (from Barrett-Connor et al. 2002)...

Ridker PM (2001) High-sensitivity C-reactive protein potential adj unct for global risk assessment in the prim ary prevention of cardiovascular disease. Circulation 103 1813— 1818... 

Once the presence of hypertension is established, the question of whether to treat and which drugs to use must be considered. The level of blood pressure, the age of the patient, the severity of organ damage (if any) due to high blood pressure, and the presence of cardiovascular risk factors all must be considered. Assessment of renal function and the presence of proteinuria are useful in... 

The patient s fasting lipid panel, cardiovascular risk factors, and dietary and exercise habits will be assessed. 

Ridker PM, Wilson PW, Grundy SM. Should C-reactive protein be added to metabolic syndrome and to assessment of global cardiovascular risk Circulation 2004 109 281 8-2825,... 

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