Cardiovascular Prevention in High Risk Patients: Evaluating Current Evidence to Improve Outcomes in Managed Care

Faculty

Needs Statement

CVD affects approximately 80 million Americans and is responsible for roughly one third of US mortality, with nearly 2400 CVD-associated deaths occurring each day—more than cancer, chronic lower respiratory diseases, accidents, and diabetes mellitus combined ¹. CVD is associated with an estimated total annual cost of $400 billion. Among the identified modifiable risk factors for CVD are smoking, high cholesterol, hypertension, physical inactivity, obesity, and diabetes mellitus²; in addition, the aging of the US population also contributes to the incidence of CVD,¹; as more than 80% of individuals who die from coronary heart disease are 65 years of age or older.² Practice guidelines such as the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, the Clinical Practice Guidelines for Cholesterol Management in Adults, and the American Heart Association Guidelines for Primary Prevention of Cardiovascular Disease and Stroke are available to guide clinicians and managed markets professionals in cardiovascular prevention and treatment, addressing the use of both nonpharmacologic and pharmacologic modalities.^3-5 Nonpharmacologic interventions include smoking cessation, exercise, and dietary changes.  Among the pharmacotherapeutic interventions available for cardiovascular prevention are diuretics, beta-blockers, calcium channel blockers, angiotensin-converting enzyme inhibitors, and angiotensin receptor blockers for the management of hypertension, and statins for the management of high cholesterol. As data continue to emerge regarding the effectiveness of traditional and new pharmacologic interventions in cardiovascular prevention, evidence suggests the importance of an individualized approach to patient care. To implement personalized treatment strategies and achieve optimal patient outcomes, managed markets physicians and pharmacists require education on patient-specific screening methods and current evidence for preventive cardiovascular measures.

References:
1. Rosamond W, Flegal K, Friday G, et al. Heart disease and stroke statistics—2007 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2007;115:e69-e171.
2. Risk Factors and Coronary Heart Disease. American Heart Association Web site. Available at: http://www.americanheart.org/presenter.jhtml?identifier=4726. Accessed June 9, 2008.
3. Chobanian AV, Bakris GL, Black HR, et al. Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension. 2003;42:1206–1252.
4. Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). National Heart, Lung and Blood Institute Web site.
http://www.nhlbi.nih.gov/guidelines/cholesterol/index.htm. Accessed June 9, 2008.
5. Pearson TA, Blair SN, Daniels SR, et al. AHA Guidelines for Primary Prevention of Cardiovascular Disease and Stroke: 2002 Update: Consensus Panel Guide to Comprehensive Risk Reduction for Adult Patients Without Coronary or Other Atherosclerotic Vascular Diseases. American Heart Association Science Advisory and Coordinating Committee. Circulation. 2002;106:388-391.

Target Audience

This activity is designed for managed markets physicians and pharmacists.

Objectives

After completing this activity, participants should be able to:
1. Describe the clinical and cost burden of cardiovascular disease (CVD) in the United States and frequent barriers to cardiovascular prevention;
2. Summarize nonpharmacologic and pharmacologic interventions for secondary prevention of CVD;
3. Outline emerging data on pharmacologic approaches to cardiovascular prevention;
4. Put into practice current guidelines and evidence to assist providers in improving outcomes in cardiovascular prevention for high-risk patients.

To be eligible for credit, participants must participate in the full educational activity, complete the post-test with a score of 70% or better, and complete the online evaluation form. 

Accreditation

Medicine
The University of Kentucky College of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The University of Kentucky College of Medicine designates this educational activity for a maximum of 1.00 AMA PRA Category 1 Credits™. Each physician should claim only those hours of credit actually spent in the educational activity.

The University of Kentucky College of Medicine presents this activity for educational purposes only. Participants are expected to utilize their own expertise and judgment while engaged in the practice of medicine. The content of the presentations is provided solely by presenters who have been selected for presentations because of recognized expertise in their field.

Pharmacy
Princeton CME is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education (ACPE Provider #452) and complies with the Criteria for Quality and Interpretive Guidelines. This activity is approved for 1 contact hour (0.1 CEU) of continuing pharmacy education (UPN 452-999-08-020-H01-P).

Any participant wanting to file a grievance with respect to any aspect of a continuing pharmacy education activity accredited by Princeton CME may contact John Savage, Director, Medical Education, North American Center for Continuing Medical Education (NACCME)-Princeton CME, in writing. The Director of Medical Education will review the grievance and respond within 30 days of receiving the written statement. If the participant is unsatisfied with the response, an appeal to the Vice President, Medical Education, NACCME-Princeton CME, may be made for a second level of review.

John Savage
NACCME-Princeton CME
300 Rike Drive, Suite A
Millstone Township, NJ 08535
E-mail: jsavage@naccme.com

Faculty Disclosure

Drs. Blumenthal, Cardarelli and Rivera report no relevant financial relationships with commercial interests of healthcare products or services related to this activity.

Dr. Fintel serves as a consultant to Bristol-Myers Squibb, sanofi-aventis, Schering-Plough Corporation and The Medicines Company; and serves on the Speakers’ bureau for AstraZeneca, Bristol-Myers Squibb, Merck, sanofi-aventis, Schering-Plough and The Medicines Company.

Dr. Sorrentino serves on the Speakers’ bureau for Merck, Novartis, Pfizer and Takeda.

No members of the planning committee report any relevant financial relationships with commercial interests of healthcare products or services related to this activity.

This educational activity does not contain discussion of off-label or investigational use of drugs or devices.

 

Activity Sponsorship

Supported by an educational grant from Boehringer-Ingelheim Pharmaceuticals, Inc.