Lowering Your Risk of Cardiovascular Disease

An ounce of prevention is worth a pound of cure.

Cardiologists and prevention experts at the Cardiovascular Institute (CVI) of Rhode Island, The Miriam and Newport hospitals could not agree more.

Proactive steps like not smoking, maintaining cardiac fitness and controlling abnormal blood cholesterol play a critical role in avoiding a first or recurrent cardiovascular event, like a heart attack, stent, bypass or stroke.

The Center for Cardiac Fitness and CVI’s Lipid and Prevention Program work individually, and often together, to identify cardiac risk in patients, and to create individual prevention plans focused on reducing this risk.

“Preventive steps are absolutely critical. For example, data show that exercise is associated with a 35-percent reduction in your first or second cardiovascular event, no matter what your body weight may be,” explains Hank Wu, MD, medical director for the Center for Cardiac Fitness.

The cardiac fitness program offers expertise aimed at helping patients find a correct balance of exercise, nutrition and stress management. This service is provided within a safe, supervised environment. The fitness program is part of a comprehensive cardiovascular program that also includes the CVI’s lipid and prevention program, a practice-based collaborative care program that focuses on patients with known cholesterol issues, especially complex disorders, or family histories of early heart attack.

Am I at Risk?

In many cases, diet and lifestyle change, including exercise, smoking cessation and healthy eating, can prevent a cardiovascular event, including heart attack. Unfortunately, heart disease remains the number one cause of death in the United States. Most people are unaware of the powerful effects of diet, lifestyle, and medications to control blood cholesterol and blood pressure on reducing cardiovascular risk.

Indicators of cardiac risk include:

• High blood pressure
• Abnormal cholesterol levels
• Obesity and overweight
• Cigarette smoking
• Lack of physical activity
• Family history
• Diabetes
• Peripheral vascular disease

“The general population needs to be educated about heart disease prevention to make sure a cardiac event doesn’t happen,” Wu says.

Karen E. Aspry, MD, who heads up the lipid program, adds, “Most people are unaware that an estimated 75 percent of heart attacks are preventable, and that individual risk can be reduced dramatically when prevention efforts begin early.”

Taking the First Step

Patients have different paths to the CVI’s prevention services.

A primary care provider may refer a patient to the Lipid and Prevention Program when a complex cholesterol concern arises, or patients may refer themselves if their insurance allows.

Aspry, the only cardiologist in Rhode Island with board certification in clinical lipidology, says the program specializes in patients who have:

• Severe cholesterol disorders
• Poor cholesterol control despite medication
• Intolerance to cholesterol-lowering medication
• Personal or family histories of early coronary heart disease

“Primary care physicians and cardiologists are very good at managing cholesterol. However, they often seek help when patients have complex or severe cholesterol problems or difficulty taking cholesterol-lowering medication, or when it’s not clear if treatment is needed,” explains Aspry. “We also help diagnose suspected genetic cholesterol disorders, which is critical for identifying family members who may benefit from cascade screening.”

Aspry performs a comprehensive evaluation for every patient based on his or her baseline cholesterol profile, and family and personal history. In some cases, advanced lab testing is performed, available through Lifespan or a lab partner, to help make a diagnosis, or to reduce ‘residual risk.’ The clinic also tracks lipid outcomes for patients who return, and has a collaborative model, with CVI nurse Deborah Johnson-Kenney providing between-visit care.

Aspry says family history and genetics are important considerations. She pointed to Rhode Island’s large population of French Canadians, who have an increased incidence of familial hypercholesterolemia, which is under-diagnosed, undertreated and associated with high cardiovascular risk.

“Genome-wide studies have shown that there are almost 50 genetic factors that associate with early vascular disease, and a large proportion relate to abnormal blood lipids,” explains Aspry.

She adds that part of her program’s emphasis is helping ensure that medications do not impact quality of life. “We understand how difficult it is for patients to take a medication every day, especially if they are experiencing side effects. We use alternative dosing regimens and always look for factors that may explain why side effects are occurring. We hope to be using a promising new class of cholesterol-lowering medications within the year for those who have been intolerant of statins.”

Aspry and her team are not solely prescribing medication. Dr. Aspry has a background in human nutrition. She counsels each patient on diet and lifestyle changes known to improve blood lipids, which dovetails with Dr. Wu and his team. The lipid clinic has also partnered with nutrition scientist and Mediterranean diet expert Mary Flynn, RD, PhD, for patients who wish longer one-on-one diet counseling sessions.

“Medication and diet intervention through the lipid clinic, and lifestyle modification services offered at the Center for Cardiac Fitness, provide Lifespan patients and employees with a full complement of cardiovascular disease prevention services,” explains Aspry.

Specialized, Safe Cardiac Fitness

The Center for Cardiac Fitness is a medically supervised program with a team of cardiologists, nurses, exercise physiologists, nutritionists, a psychologist and a physical therapist. The state-of-the-art facility includes telemetry equipment.

The center is one of only a few in Rhode Island to be accredited by the American Association of Cardiovascular and Pulmonary Rehabilitation. Its team creates a treatment plan based on the severity of each patient's cardiac condition and functional ability. Personalized baseline diagnostic testing and regular medical monitoring is another aspect of the service.

Wu says that the majority of patients who take advantage of the center’s services have already experienced a cardiac episode. They have suffered a heart attack and seek out cardiac rehabilitation focused on getting them back to their previous activity level or better.

Once patients build up their strength, a maintenance program is offered that provides monitored exercise and coaching, as well as education and psychological help toward long-term health.

For hundreds of individuals, the rehab program has been life-changing and helps curb the likelihood of further cardiac events. Ideally, though, Wu would like to see more patients benefiting from The Center for Cardiac Fitness’s third prong of services, Health for Life, to hopefully prevent their first cardiovascular episode.

Health for Life is designed for individuals who have not had a cardiac event but are referred to the program by physicians due to high cardiac risk. Patients will work with the center’s team to do a full assessment to consider physical, nutritional and psychological aspects that might be hampering cardiac health.

“The center is not a gym. It’s a medical prevention program,” explains Wu. “We use a multifaceted approach to achieve cardiac health and prevention.”

Health for Life services include monitored exercising, coaching and nutrition counseling. Innovative patient education is a key part of the program. Regular services include healthy cooking demonstrations by Johnson & Wales University culinary students and visits to supermarkets hosted by nutritionists who discuss healthy foods and how to read nutrition fact labels.

Wu added that the center has flexible session hours, advanced equipment, and experts who tailor resistance and strengthening exercises to the needs of all participants.