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COVID-19 and Cardiovascular Disease—Two Pandemics, One Success

World Journal of Cardiovascular Diseases 2023年第4期13卷 236-242页

作者： Robert Philip Eaton barry ramo Martin Hickey David S. Schade Division of General Internal Medicine University of New Mexico School of Medicine Albuquerque NM USA New Heart Fitness and Health Albuquerque NM USA New Mexico State Senator Albuquerque NM USA

Background: COVID-19 has had a major impact on all facets of life in the United States. Its devastating effects have resulted in the mobilization of major resources, both at the national, state, and individual levels. This mobilization has resulted in vaccination, personal preventive measures, and new therapies to combat this illness. As a result, the rates of new infections, hospitalizations, and deaths have greatly diminished, minimizing the associated morbidity and mortality. Purpose: What has not been appreciated is that a more serious epidemic has continued unabated in the United States and the Western world. This article emphasizes the importance of a national effort to eradicate cardiovascular disease. Methods: Cardiovascular disease has caused more deaths than COVID-19 in almost all months since the COVID-19 epidemic was first recognized in December 2020. In fact, cardiovascular disease has caused more deaths than either all cancers combined or infections for the last two decades. The tragedy of this truth is that effective therapy is currently available for preventing and reversing cardiovascular disease at a very low cost. What is required is a concerted effort and commitment by all legislative and medical organizations to allocate the resources to abolish asymptomatic cardiovascular disease. Results: Recognition and mobilization of resources to combat this epidemic are much overdue with the resultant savings of lives and billions of dollars. It is past time for the medical establishment to support the national identification of asymptomatic cardiovascular disease and initiate treatment before patients become symptomatic with this deadly disease. Conclusion: The national experience with COVID-19 has demonstrated what can be accomplished when a national concerted effort is made to address a devastating medical epidemic. This commitment is not only feasible for cardiovascular disease, but is also necessary for the benefit of all people in the world.

关键词： Epidemic Cardiovascular COVID-19 Heart Attack Death Rate

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The Application of the LDL Principle

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World Journal of Cardiovascular Diseases 2016年第5期6卷 109-125页

作者： David S. Schade Brendan Cavanaugh barry ramo R. Philip Eaton Division of Endocrinology DoIM School of Medicine University of New Mexico Albuquerque NM USA New Mexico Heart Institute Albuquerque NM USA

The LDL Principle has recently been invoked to describe the observation that lowering the LDL cholesterol (by whatever means) results in a lowering of atherosclerotic cardiovascular events. The scientific basis of the LDL Principle dates back to the discovery that the LDL receptor is the prime determinant of the circulating LDL-c concentration. Since that time, major advances have been made at both the basic and clinical science level in our understanding of the pathogenesis and reversal of atherosclerosis. The incorporation of atherogenic lipoproteins plus inflammatory mediators into plaque formation permits the targeted intervention into preventing plaque rupture. In addition, genetic studies identifying individuals with unique phenotypes of either abnormally high or low LDL-c concentrations have provided insight into possible therapeutic modalities that have recently provided the physician with the tools necessary to apply the LDL Principle to achieve reversal of atherosclerosis. The epidemic of atherosclerotic cardiovascular disease has resulted in numerous randomized controlled intervention trials in an attempt to identify approaches to reduce ASCD morbidity and mortality. Recently published data indicate that circulating LDL-c levels of 50 mg/dl or less are not only physiologic at birth but also effective in greatly reducing cardiovascular disease. In addition, the recent availability of two PCSK9 inhibitors provides the primary care physician with the possibility of achieving this low level of LDL-c even in statin intolerant patients. The widespread availability of the coronary artery calcium scan plus the inclusion of traditional cardiovascular risk factors in risk assessment has enabled the physician to readily identify asymptomatic individuals at high risk for cardiovascular events. Aggressively applying the LDL Principle to these individuals has the potential of greatly reducing cardiovascular mortality. This review will document the scientific basis for

关键词： LDL Principle Atherosclerosis Myocardial Infarction Atherosclerosis Reversal LDL Cholesterol

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The Rationale for a Different Approach to Preventing Cardiovascular Disease

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World Journal of Cardiovascular Diseases 2019年第7期9卷 489-510页

作者： David S. Schade barry ramo S. Scott Obenshain Ron Schrader R. Philip Eaton Division of Endocrinology Department of Internal Medicine University of New Mexico Health Sciences Center Albuquerque NM USA New Heart Fitness and Health Albuquerque NM USA Department of Pediatrics University of New Mexico Health Sciences Center Albuquerque NM USA Department of Mathematics University of New Mexico Albuquerque NM USA

The Problem: We have previously suggested that an alternative approach to preventing cardiovascular disease is necessary because atherosclerotic cardiovascular disease (ASCVD) has been increasing for the last 50 years and has now reached epidemic status. Since the year 2000, approximately 600,000 heart attacks and ASCVD related deaths have occurred annually in the United States. It is the most common cause of death in the U.S., more than all cancers combined. The financial costs are staggering, amounting to 555 billion dollars per year in direct and indirect costs. Outlook for an improvement in these statistics is not encouraging as the U.S. population continues to become more obese and to develop diabetes. The Question: Why is ASCVD continuing to be a major challenge to healthcare providers when the pathogenesis is known and inexpensive preventative treatment is available? The reasons are multiple and complex. First, present financial reimbursement policies of healthcare organizations reward treatment of a disease and its complications instead of preventing the disease. Second, professional guidelines and treatment goals are often too complex, subject to interpretation, and time-consuming to be useful in the clinical setting. Third, no specific follow-up of patients at risk for ASCVD is recommended when the risk assessment changes. Fourth, many expensive cardiovascular diagnostic tests are utilized without meeting appropriate guidelines for their use. Fifth, treatment of individuals without first proving the presence of disease results in poor adherence to therapy. The Solution: This article describes the rationale for a new approach to the prevention of ASCVD in asymptomatic individuals. It is based upon preventing ASCVD by identifying all asymptomatic individuals with subclinical disease before an ASCVD event occurs. It recommends that all adults be screened for ASCVD on or before the age of 50 using a non-invasive atherosclerosis specific coronary artery calcium

关键词： Cardiovascular Disease Preventing ASCVD

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