Cardiovascular Disease

Treatment and management for CVD is extensive and depends on the clinical situation. Some people with CVD may need surgery, depending on the type of heart disease and the amount of damage to the heart. These include commonly performed surgical procedures like coronary artery bypass grafting (CABG), non-surgical procedures like percutaneous coronary intervention (PCI), or minimally invasive procedures like catheter ablation, among many others.³

Coronary artery bypass grafting (also known as bypass surgery) is the most common heart operation performed by cardiac surgeons, with almost 400,000 procedures completed in the United States each year to treat coronary artery disease.^10,11 While remaining the most common major surgical procedure, the total number of operations performed has decreased in recent years, as alternative, minimally invasive treatment approaches such as PCI have increased.¹² Unlike CABG, which is traditionally an open-heart surgical procedure where coronary artery blockages are bypassed with harvested venous or arterial conduits, PCI is a non-surgical procedure where the clinician uses a catheter to place a stent with the goal of opening blood vessels in the heart that were previously narrowed by atherosclerosis.^12,13 The primary indications for PCI are angina pectoris, myocardial ischemia, and acute myocardial infarction.¹³ About 80% of PCIs are performed with stents, although some procedures are performed without stenting.¹³

Catheter ablation for atrial fibrillation is a minimally invasive surgical procedure that involves either burning or freezing a small area of the heart. This causes some scarring on the inside of the heart to help break up the electrical signals that were creating an irregular heartbeat.¹⁴ Although atrial fibrillation affects patients with a prevalence greater than 10% after 80 years of age, it can occur in relatively younger patients as well. A recent study found that catheter ablation for patients younger than 50 years of age who underwent catheter ablation had a lower risk of readmission for atrial fibrillation or any cause at 1 year compared with those who were not treated with catheter ablation.¹⁵

Cardiovascular surgery is common not only with patients who have heart disease or other cardiovascular risk factors, but also those at high-risk for developing these problems. To lessen one’s risk for heart surgery, clinicians should communicate the need for secondary prevention through the modification of risk factors and lifestyle for patients with known CVD. Patient-centered approaches to comprehensive cardiovascular risk prevention should include team-based care and shared decision-making. Clinicians’ advice should consider the patients’ socioeconomic and educational status, as well as cultural, work, and home environments.⁹

Team-based care is an approach that involves a variety of health care professionals working together to improve the quality of care and maintenance of CVD prevention. This multifaceted approach supports clinical decision-making using treatment algorithms, encourages collaboration among clinicians, and involves patients and their family members to facilitate treatment goals. Additionally, collaboration between clinicians and patients is crucial when deciding primary prevention.⁹

In young adults aged between 20 and 39 years with high blood cholesterol, estimating their lifetime risk and adopting a healthy lifestyle is recommended. In most cases, medication therapy is only recommended for those with moderately high LDL-C (≥ 160 mg/dL) or those with very high LDL-C (≥ 190 mg/dL). For adults aged between 40 and 75 years, the decision to prescribe statin treatment should be based on their 10-year atherosclerotic CVD risk. The higher the estimated risk, the more likely the patient will benefit from statin treatment. For patients over 75 years of age, it is essential to assess their risk status and discuss risk with the patient when deciding whether to initiate or continue statin treatment.⁹ Statin treatments include atorvastatin, fluvastatin, lovastatin, pravastatin, rosuvastatin calcium, and simvastatin. Other cholesterol-lowering therapies include ezetimibe, bile acid sequestrants, PCSK9 inhibitors, adenosine triphosphate-citrate lyase inhibitors, fibrates, niacin, omega-3 fatty acid ethyl esters, and marine-derived omega-3 polyunsaturated fatty acids.¹⁶

Nonpharmacological interventions are recommended for adults with elevated blood pressure or hypertension, including those requiring antihypertensive medications. These interventions include weight loss, a healthy diet, sodium reduction, potassium supplementation, a structured exercise program, and limited alcohol intake. Blood pressure-lowering medications are recommended in adults with an estimated 10-year CVD risk of 10% or higher, an average systolic blood pressure of 130 mm Hg or higher, or an average diastolic blood pressure of 80 mm Hg or higher.⁹ Diuretics, beta-blockers, angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, calcium channel blockers, alpha-blockers, alpha-2 receptor agonists, combined alpha and beta-blockers, and vasodilators are all classes of blood pressure medications.¹⁷

The FDA approved the first anti-inflammatory medication for CVD in June of 2023.¹⁸ Research shows that colchicine 0.5 mg reduces the risk of cardiac events in adults with established atherosclerotic CVD by an additional 31% compared with the standard of care alone.¹⁹ Additionally, sotagliflozin, a sodium-glucose cotransporter 1 and 2 inhibitor, was approved in May of 2023 by the FDA for reducing the risk for cardiovascular death, hospitalization for heart failure, and for preventing death and hospitalization in patients with type 2 diabetes, chronic kidney disease, and other cardiovascular risk factors.²⁰

As CVD involves many components, a multidisciplinary approach to care is typically holistic and patient-centered. The composition of a multidisciplinary team can vary depending on patient needs. It may involve a cardiologist, cardiac surgeon, vascular surgeon, primary care physician, cardiovascular nurse, pharmacist, dietitian, rehabilitation specialist, and social worker. Managing CVD through a multidisciplinary team improves patient outcomes and is a critical component for the successful delivery of cardiovascular care.²¹