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Peter Toth, MD, PhD, sits down for a Q&A related to updates from the ASPC 2022 meeting and trends topics in preventive cardiology, including aspirin use and blood pressure management.
Preventive cardiology treads a unique line in medicine. A field with perhaps the most tangible impact on public health, but often underappreciated as a cog in public health efforts.
The cardiovascular disease epidemic raged for decades, and it was not until advances in preventive cardiology, including a new emphasis on cardiovascular risk factors and lifestyle behaviors, that rates of cardiovascular disease began to plateau in the US. Still, most cardiologists will acknowledge there is work to be done in regard to optimizing prevention and prevention strategies among patients.
This aim helped to drive the agenda of the American Society for Preventive Cardiology (ASPC) 2022 Congress on CVD Prevention. At the meeting, which was held from July 29-31 in Louisville, KY, topics of interest included blood pressure, the heart-brain axis, aspirin usage, primordial Prevention, the cost of prevention, and Overcoming Barriers in the Treatment of Diabetes in Clinical Practice, among others. With an interest in learning more about the meeting and trending topics in preventive cardiology, Practical Cardiology reached out to Peter Toth, MD, director of Preventive Cardiology at CGH Medical Center and former president of the ASPC, for further perspective.
Practical Cardiology: While the ASPC program is meticulously planned, were there any items of focus that seemed to be trending among attendees more than others?
Peter Toth, MD: I think it's mostly interest in what is practical, what can I take back to my practice to improve patient care. The ASPC is about getting back to basics. It's about making sure that our members have the tools as well as the knowledge to go back and practice state-of-the-art medicine, to make sure they are practicing contemporary medicine, and that their patients are meeting guideline-directed goals or targets. This is extremely important, because we know not only nationwide, but worldwide, risk factor goal attainment rates are very, very, very poor.
The only way to change this really is to do it one patient at a time, you can jump up and down and write more guidelines and you can write more journal articles, but the bottom line is that sometimes people just need to hear it. They need to hear someone explain it and explain it in a way that is clear, concise, and that they can take back to their practice Monday morning and say, "Okay, here's what I need to do in this situation and let's do it".
So, the practical was emphasized. Sure, we have some lectures that are a little bit more technical, but when it comes to providing people with information and best practices currently in diabetes, hyperlipidemia, hypertension, and established atherosclerotic cardiovascular disease, this is all very hands-on clinical stuff and our membership loves this, because they're devoted, committed, and energetic.
Practical Cardiology: Is this a novel approach or has this been the traditional motive for APSC meetings?
Peter Toth, MD: Well, it's no secret that if you write a 150- or 200-page guideline, not many are going to read it. They don't have time and they need something more condensed, something very focused and something that they will remember. This is where an organization like the ASPC comes in, because our conferences are very, very clinic focused and I think that's a good thing. As a result of this, you're improving care, you're helping to optimize resource allocation utilization, and you are using technology appropriately. Let's take the case of coronary artery calcium, coronary artery CT angiography, or magnetic resonance imaging, we had a 2-day course, which helped clinicians understand precisely where to position each of these technologies and how best to use them.
Practical Cardiology: As the outgoing president of the ASPC, are there any specific areas or topics in preventive where fulfilling a knowledge gap among cardiologists and care providers could immediately improve care?
Peter Toth, MD: Yes, I think it boils down to the ABCs.
First, aspirin. How do you optimize aspirin use because, so often now, people just don't use the aspirin. Well, that's completely inappropriate. Especially, in the secondary prevention setting. In primary prevention, it takes a little bit more judgment when calculating or estimating the patient's risk for the next 10 years. However, to simply remove the benefit that aspirin offers and take it off the table is ludicrous. So, it does take judgment because you have to balance benefit against the risk of bleeding, but I think we're getting better at this, and I think this was discussed thoroughly at the conference.
Next: Blood Pressure. A blood pressure of 138 over 83 is no longer appropriate. The guideline has changed and the needle has changed. We now understand what a crucial risk factor blood pressure is and even being off by 3 over 2 can augment risk.
Lastly: Cholesterol. It is shocking that still only one-third of high-risk patients get their LDL, to their risk stratified goal. We have so many tools available to us now to help patients achieve LDL lowering so there is really no excuse for it. At a conference like ours, we provide very specific instruction on how, when, and where to use specific interventions to augment the benefit of statin therapy or, in the case of patients who are statin intolerant, how best to use other LDL-lowering approaches.
Also, cigarette smoking. My goodness, this is such a crucial risk factor, but it's an addiction and very difficult to break. It is another one of those things that we have to continually emphasize to your patients how important it is to quit smoking and tell them that we'll do whatever it takes to help them do it. It is at the top of the list. Another thing that people don't always talk about is medication adherence. So many patients are given appropriate medication, but they stop them either because they don't understand what the medication is doing or, maybe, their friends told them that the medication is bad for them—the list of reasons is long. Simply speaking with patients at every visit about the importance of adherence and helping them understand what each individual medication is doing to help reduce risk for acute cardiovascular events goes a long way toward improving adherence and compliance.
Editor’s Note: This transcript has been edited for length and clarity.