We live in an era of almost miraculous cardiovascular interventions. Cardiologists can fix heart valves without opening the chest. We can visualize the heart in real-time and in three dimensions. We can inject stem cells into damaged parts of the heart to spur regeneration. From the viewpoint of scientific discovery and innovation, it is an exciting time to be a cardiologist.
But our performance falters in our ability to help patients avoid these heroic measures in the first place. Cardiovascular disease remains the No. 1 killer in the United States. Our rates of disease in Kentucky are some of the highest in the world.
The work of preventive medicine seldom captivates the imagination and would never be deemed exciting enough for an episode of Star Trek. The majority of acts in preventive cardiology are solitary missions of self-discipline performed by patients who want to live to see their grandchildren go to school or want to avoid dying of a heart attack at age 54 like their fathers. These patients, who make difficult life changes, are my heroes and the reason I decided to pursue preventive cardiology.
For a long time, we preventive cardiologists would try to predict who was at higher risk using the Framingham Risk Score, developed by studying the population of Framingham, Mass. It is difficult to compare a "high-risk" patient from such a place to someone from Eastern Kentucky, who may have started smoking in the second grade.
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Newly developed risk scores allow physicians to make more accurate risk assessments, particularly for female and non-Caucasian patients. Newer disease markers, such as levels of calcium in cardiac blood vessels, aortic stiffness and inflammation, allow us to further pinpoint risk and increase therapies as needed. Our advanced knowledge of exercise physiology allows workouts to be more efficient and effective.
We now can perform 24-hour blood pressure monitoring, giving us a detailed picture of whether blood pressure is controlled consistently rather than the mere snapshot we get during an office visit. We also have newer agents for cholesterol control that will presumably help the 10 percent of patients who cannot tolerate conventional statin medications.
Prevention now has its own "miracles." Using these and other tools, we hope to help keep risk factors at bay. Given the amount of preventable disease in Kentucky, aiding the daily, personal battles of prevention is the most challenging and rewarding pursuit in cardiovascular medicine today — even if it doesn't make it onto Star Trek.