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 The leading web portal for pharmacy resources, news, education and careers March 21, 2018
Pharmacy Choice - Heart Disease Disease State Management - March 21, 2018

Heart Disease State Management

Heart Disease – Where are we Today?

by Alan P. Agins, BS, MS, PhD President - PRN Associates, Ltd. - Continuing Medical Education
According to the most recently published statistics from the CDC (2006), heart disease continues to cause more than 25% of deaths in the United States - making it the leading cause of death for both men and women. What can sometimes be a little confusing, however, is that the term "heart disease" is often assumed to be only the most common type of the heart diseases: coronary artery disease or coronary heart disease (CHD). But in reality, the term “heart disease” includes the various types of angina, congestive heart failure, arrhythmias, cardiomyopathy, congenital heart disease, heart valve disease, myocarditis, pericarditis, sudden cardiac death and others cardiac pathologies. Indeed, coronary heart disease (CHD) is by far the most common type of heart disease. In 2010, it was estimated that 785,000 Americans will have had a new coronary attack, and approximately 470,000 will have had a recurrent attack. That turns out to be a coronary event in this country about every 25 seconds and a death every minute. Beyond morbidity and mortality there is also a high financial price to pay for heart disease. In economic terms, it was estimated that in 2010, heart disease cost the US $316.4 billion, an amount that includes the cost of health care services, medications, and lost productivity.

The good news, and there is some good news, is that from 1996 to 2006, the death rates from cardiovascular disease (heart disease, stroke, etc) actually declined nearly 30%. Most likely that is due to greater public awareness, earlier detection and better medical / pharmacological management at both the preventative and acute care levels. The bad news, however, is that the burden of heart disease still remains quite high, and the prevalence and control (or lack thereof) of traditional risk factors still remains a major issue for many Americans. You know the drill, the usual suspects. I call them the “Dirty Half-Dozen” – Inactivity, Obesity, High Blood Pressure, Cigarette Smoking, High Cholesterol and Diabetes. Unlike the ones you’re stuck with, such as advancing age and family history, the above risk factors are "modifiable", as we know, through a combination of both lifestyle changes (ie., diet, exercise, smoking cessation) and proper medication choices. Lifestyle changes (while easy to make for 24 – 48 hours at a time) are difficult for many to sustain over the long haul. As a result many look to the pharmaceutical industry to provide the magic bullet(s). There is no question that medications do provide benefit in many areas, but they are not absolute. For example, there are no drugs for treating "inactivity" and there are very few drugs (with limited efficacy as well) for managing obesity or smoking cessation. Furthermore, we know that of the millions of people who are currently taking medications for hypertension, dyslipidemia and/or diabetes, a very large percentage of patients do not have their diseases under acceptable control with those drugs. Some of that may be provider-side issues (non-aggressive management, improper drug choices, sub-therapeutic dosing, not using rational combinations, etc). Some of it may be patient-sided issues (poor compliance with medications, lifestyle modifications, personal or lab monitoring, etc). Regardless, drugs are not the end-all, be-all at this time either.

Hopefully, the highly anticipated new guidelines for managing hypertension (JNC 8), dyslipidemia (ATP IV) and obesity (Obesity 2) which are due to be released this Spring (after years of delays) will provide better guidance for identification, prevention and/or reduction of those modifiable risk factors for heart disease. In a perfect world, this would translate into reduced morbidity and mortality from one of the leading health care problems in this country today.
Links - Heart Disease
Center For Disease Control National Center for Chronic Disease Prevention and Health Promotion Cardiovascular Health Program. Heart Disease and Cardiology Home Page Many links about heart disease, treatment and cure.

The American Heart Association is a national voluntary health agency whose mission is to reduce disability and death from cardiovascular diseases and stroke.

BBC HEALTH: The Heart Disease Guide looks at coronary heart disease, its causes and the treatments available, and how to reduce your risks of heart disease. There's also a section dedicated to heart disease organisations and support services.

British Heart Foundation aims to play a leading role in the fight against heart disease so that it is no longer a major cause of disability and premature death.

Congenital Heart Information Network is an international organization that provides reliable information, support services and resources to families of children with congenital and acquired heart disease, adults with congenital heart defects, and the professionals who work with them.

The Gum Disease - Heart Disease Project Linking Gum Disease with Heart Disease.

Helping Heart Disease Patients and Families is committed to helping heart disease patients and families/caregivers.

National Coalition for Women with Heart Disease was founded by a group of women heart attack survivors who joined together to improve the quality of life for all women who are living with heart disease.

Nutrition, Health & Heart Disease; Cause & Prevention

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