Skip to main content

A Multidisciplinary Model for Aggressive Risk Factor Control in Cardiovascular Disease

  • Chapter

Part of the book series: Contemporary Cardiology ((CONCARD))

Abstract

Critical recent insights into the epidemiology, pathophysiology, and treatment of cardiovascular disease (CVD) have served to underscore the value of primary and secondary prevention efforts. At the same time, there is growing awareness that a troubling gap exists between accepted standards for risk factor assessment and control and actual clinical practice. This is particularly so for traditional care settings in which the physician is the source of preventive services. The resulting context creates an opportunity to develop innovative and effective models for the detection and modification of CVD risk factors. This chapter reviews the background and rationale for the creation of a Preventive Cardiology Program, summarizes the design of the program developed at The Cleveland Clinic Foundation, and describes representative clinical outcomes from our initial cohort.

This is a preview of subscription content, log in via an institution.

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   74.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Levy D, Wilson P. Atherosclerotic cardiovascular disease: an epidemiologic perspective. In: Topol E, ed. Textbook of Cardiovascular Medicine. Lippincott-Raven, Philadelphia, PA, 1998, pp. 12–30.

    Google Scholar 

  2. National Center for Health Statistics. Vital Statistics of the United States. Washington, DC, US Government Printing Office, Public Health Service, 1993.

    Google Scholar 

  3. Castelli WP. Lipids, risk factors and ischaemic heart disease. Atherosclerosis 1996; 124 (9): S1–S9.

    Article  PubMed  CAS  Google Scholar 

  4. Wolf P. Cerebrovascular risk. In: Izzo J, Black H, eds. Hypertension Primer: The Essentials of High Blood Pressure. Lippincott Williams and Wilkins, Baltimore, MD, 1999, pp. 203–207.

    Google Scholar 

  5. AHA. Statistical Update, American Heart Association. 1999.

    Google Scholar 

  6. Johnson CL, Rifkind BM, Sempos CT, et al. Declining serum total cholesterol levels among US adults. The National Health and Nutrition Examination Surveys. JAMA 1993; 269 (23): 3002–3008.

    Article  PubMed  CAS  Google Scholar 

  7. Thom T, Roccella E. Trends in blood pressure control and mortality. In: Izzo J, Black H, eds. Hypertension Primer: The Essentials of High Blood Pressure. Lippincott Williams and Wilkins, Baltimore, MD, 1999, pp. 268–270.

    Google Scholar 

  8. Goldman L, Cook EF. The decline in ischemic heart disease mortality rates. An analysis of the comparative effects of medical interventions and changes in lifestyle. Ann Intern Med 1984; 101 (6): 825–836.

    PubMed  CAS  Google Scholar 

  9. Rosamon WD, Chambless LE, Folson AR, et al. Trends in the incidence of myocardial infarction and in mortality due to coronary heart disease, 1987 to 1994. N Engl J Med 1998; 339 (13): 861–867.

    Article  Google Scholar 

  10. Kelly DT. Paul Dudley White International Lecture. Our future society. A global challenge. Circulation 1997; 95 (11): 2459–2464.

    Article  PubMed  Google Scholar 

  11. Kannel W. The Framingham experience. In: Marmot M, Elliott P, eds. Coronary Heart Disease Epidemiology: From Aetiology to Public Health. Oxford University Press, New York, 1992, pp. 67–82.

    Google Scholar 

  12. Kannel W, Wilson W. Cardiovascular risk factors and hypertension. In: Izzo J, Black H, eds. Hypertension Primer: The Essentials of High Blood Pressure. Lippincott Williams and Wilkins, Baltimore, MD, 1999, pp. 199–202.

    Google Scholar 

  13. Lowe LP, Greenland P, Ruth KJ, et al. Impact of major cardiovascular disease risk factors, particularly in combination, on 22-year mortality in women and men. Arch Intern Med 1998; 158 (18): 2007–2014.

    Article  PubMed  CAS  Google Scholar 

  14. Califf RM, Armstrong PW, Carver JR, et al. 27th Bethesda Conference: matching the intensity of risk factor management with the hazard for coronary disease events. Task Force 5. Stratification of patients into high, medium and low risk subgroups for purposes of risk factor management. J Am Coll Cardiol 1996; 27 (5): 1007–1019.

    Article  PubMed  CAS  Google Scholar 

  15. Kannel WB, Wilson PW. An update on coronary risk factors. Med Clin North Am 1995; 79 (5): 951–971.

    PubMed  CAS  Google Scholar 

  16. Ballantyne CM. Current thinking in lipid lowering. Am J Med 1998; 104 (6A); 33S–41S.

    Article  PubMed  CAS  Google Scholar 

  17. Downs JR, Clearfield M, Weis S, et al. Primary prevention of acute coronary events with Lovastatin in men and women with average cholesterol levels. JAMA 1998; 279: 1615–1622.

    Article  PubMed  CAS  Google Scholar 

  18. Sacks FM, Pfeffer MA, Moye LA, et al. The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels. Cholesterol and Recurrent Events Trial investigators. N Engl J Med 1996; 335 (14): 1106–1110.

    Article  Google Scholar 

  19. Shepherd J, Cobbe SM, Ford I, et al. Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia. West of Scotland Coronary Prevention Study Group. N Engl J Med 1995; 333 (20): 1301–1307.

    Article  PubMed  CAS  Google Scholar 

  20. The Long-Term Intervention with Pravastatin in Ischaemic Disease (LIPID) Study Group. Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels. N Engl J Med 1998; 339 (19): 1349–1357.

    Article  Google Scholar 

  21. The Scandinavian Simvastatin Survival Study (4S). Randomized trial of cholesterol lowering in 4444 patients with coronary heart disease. Lancet 1994; 344 (8934): 1383–1389.

    Google Scholar 

  22. Furberg CD, Adams HP Jr, Applegate WB, et al. Effect of lovastatin on early carotid atherosclerosis and cardiovascular events. Asymptomatic Carotid Artery Progression Study (ACAPS) Research Group. Circulation 1994; 90 (4): 1679–1687.

    Article  PubMed  CAS  Google Scholar 

  23. Furberg CD, Byington RP, Crouse JR, et al. Pravastatin, lipids, and major coronary events. Am J Cardiol 1994; 73 (15): 1133–1134.

    Article  PubMed  CAS  Google Scholar 

  24. Herbert PR, Gaziano JM, Chan KS, et al. Cholesterol lowering with statin drugs, risk of stroke, and total mortality. An overview of randomized trials. JAMA 1997; 278 (4): 313–321.

    Article  Google Scholar 

  25. Department of Health and Human Services. The Health Benefits of Smoking Cessation: A Report of the Surgeon General, Rockville, MD, 1990.

    Google Scholar 

  26. Department of Health and Human Services. Services. The health consequences of smoking: cardiovascular disease. A Report of the Surgeon General. Rockville, MD, 1983.

    Google Scholar 

  27. SHEP Cooperative Research Group. Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. Final results of the Systolic Hypertension in the Elderly Program (SHEP). JAMA 1991; 265 (24): 3255–3264.

    Article  Google Scholar 

  28. Collins R, Peto R, MacMahon S, et al. Blood pressure, stroke, and coronary heart disease. Part 2, short-term reductions in blood pressure: overview of randomized drug trials in their epidemiological context. Lancet 1990; 335 (8693): 827–838.

    Article  PubMed  CAS  Google Scholar 

  29. Cutler J, Psaty B, MacMahon S, et al. Public health issues in hypertension control: what has been learned from clinical trials. In: Laragh J, Brenner B, eds. Hypertension: Pathophysiology, Diagnosis and Management, 2nd ed. Raven Press, New York, 1995, vol. 1, 253–270

    Google Scholar 

  30. Hebert PR, Fiebach NH, Eberlein KA, et al. The community-based randomized trials of pharmacologic treatment of mild-to-moderate hypertension. Am J Epidemiol 1988; 127 (3): 581–590.

    PubMed  CAS  Google Scholar 

  31. Hebert PR, Moser M, Jayer J, et al. Recent evidence on drug therapy of mild-to-moderate hypertension and decreased risk of coronary heart disease. Arch Intern Med 1993; 153 (5): 578–581.

    Article  PubMed  CAS  Google Scholar 

  32. Pasternak RC, Grundy SM, Levy D, et al. 27th Bethesda Conference: matching the intensity of risk factor management with the hazard for coronary disease events. Task Force 3. Spectrum of risk factors for coronary heart disease. J Am Coll Cardiol 1996; 27 (5): 978–990.

    Article  PubMed  CAS  Google Scholar 

  33. Hennekens CH, Dyken ML, Fuster V. Aspirin as a therapeutic agent in cardiovascular disease: a statement for healthcare professionals from the American Heart Association. Circulation 1997; 96 (8): 2751–2753.

    Article  PubMed  CAS  Google Scholar 

  34. Summary of the second report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel II) [comment]. JAMA 1993; 269 (23): 3015–3023.

    Article  Google Scholar 

  35. Lorgeril MD, Salen P, Martin J-L, et al. Mediterranean diet, traditional risk factors and the rate of cardiovascular complications after myocardial infarction: Final Report of the Lyon Diet Heart Study. Circulation 1999; 99: 779–785.

    Article  PubMed  Google Scholar 

  36. Garber AJ. Vascular disease and lipids in diabetes. Med Clin North Am 1998; 82 (4): 931–948.

    Article  PubMed  CAS  Google Scholar 

  37. Aronson D, Rayfield E. Diabetes. In: Topol E, ed. Textbook of Cardiovascular Medicine. Lippincott-Raven, Philadelphia, PA, 1998, pp. 171–194.

    Google Scholar 

  38. Haffner SM, Lehto S, Ronnemaa T, et al. Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. N Engl J Med 1998; 339 (4): 229–234.

    Article  PubMed  CAS  Google Scholar 

  39. Sobel B. Complications of diabetes: macrovascular disease. In: Olefsky J, ed. Current Approaches to the Management of Type 2 Diabetes: A Practical Monograph. National Diabetes Education Initiative, Secaucus, NJ, 1997, pp. 27–30.

    Google Scholar 

  40. Meig JB, Singer DE, Sullivan LM, et al. Metabolic control and prevalent cardiovascular disease in noninsulin-dependent diabetes mellitus (NIDDM): The NIDDM Patient Outcome Research Team. Am J Med 1997; 102 (1): 38–47.

    Article  Google Scholar 

  41. Powell KE, Thompson PD, Caspersen CJ, et al. Physical activity and the incidence of coronary heart disease. Ann Rev Public Health 1987; 8: 253–287.

    Article  CAS  Google Scholar 

  42. Blair SN, Kampert JB, Kohl W 3rd, et al. Influences of cardiorespiratory fitness and other precursors on cardiovascular disease and all-cause mortality in men and women. JAMA 1996; 276 (3): 205–210.

    Article  PubMed  CAS  Google Scholar 

  43. Blair SN, Kohl HW 3rd, Barlow CE, et al. Changes in physical fitness and all-cause mortality. A prospective study of healthy and unhealthy men. JAMA 1995; 273 (14): 1093–1098.

    Article  PubMed  CAS  Google Scholar 

  44. Erikssen G, Liestol K, Bjornholt J, et al. Changes in physical fitness and changes in mortality. Lancet 1998; 352 (9130): 759–762.

    Article  PubMed  CAS  Google Scholar 

  45. Wannamethee SG, Shaper AG, Walker M. Changes in physical activity, mortality, and incidence of coronary heart disease in older men. Lancet 1998; 351 (9116): 1603–1608.

    Article  PubMed  CAS  Google Scholar 

  46. NIH Consensus Development Panel on Physical Activity and Cardiovascular Health. Physical activity and cardiovascular health. JAMA 1996; 276 (3): 241–246.

    Article  Google Scholar 

  47. Pasternak RC, Grundy SM, Levy D, et al. 27th Bethesda Conference: matching the intensity of risk factor management with the hazard for coronary disease events. Task Force 3. Spectrum of risk factors for coronary heart disease. J Am Coll Cardiol 1996; 27 (5): 978–990.

    Article  PubMed  CAS  Google Scholar 

  48. Niebauer J, Hambrecht R, Velich T, et al. Attenuated progression of coronary artery disease after 6 yr of multifactorial risk intervention: role of physical exercise. Circulation 1997; 96 (8): 2534–2541.

    Article  PubMed  CAS  Google Scholar 

  49. Eckel RH. Obesity and heart disease: a statement for healthcare professionals from the Nutrition Committee, American Heart Association. Circulation 1997; 96 (9): 3248–3250.

    Article  PubMed  CAS  Google Scholar 

  50. Kannel WB, D’Agostino RB, Cobb JL. Effect of weight on cardiovascular disease. Am J Clin Nutr 1996; 63 (3 Suppl): 419S–422S.

    PubMed  CAS  Google Scholar 

  51. Schwartz MW, Brunzell JD. Regulation of body adiposity and the problem of obesity. Arterioscler Thromb Vasc Biol 1997; 17 (2): 233–238.

    Article  PubMed  CAS  Google Scholar 

  52. Rosenbaum M, Leibel RL, Hirsch J. Obesity. N Engl J Med 1997; 337 (6): 396–407.

    Article  PubMed  CAS  Google Scholar 

  53. Stone N. Diet, nutritional issues, and obesity. In: Topol E, ed. Textbook of Cardiovascular Medicine. Lippincott-Raven, Philadelphia, PA, 1998, pp. 31–58.

    Google Scholar 

  54. Helmer D, Ragland D, Syme S. Hostility and coronary heart disease. Am J Epidemiol 1991; 133: 112–122.

    PubMed  CAS  Google Scholar 

  55. Barefoot JC, Schroll M. Symptoms of depression, acute myocardial infarction, and total mortality in a community sample. Circulation 1996; 93 (11): 1976–1980.

    Article  PubMed  CAS  Google Scholar 

  56. Frasure-Smith N, Lesperance F, Talajic, M. Depression following myocardial infarction. Impact on 6-month survival. JAMA 1993; 270 (15): 1819–1825.

    Article  PubMed  CAS  Google Scholar 

  57. Frasure-Smith N, Lesperance F, Talajic, M. Depression and 18-month prognosis after myocardial infarction. Circulation 1995; 91 (4): 999–1005.

    Article  PubMed  CAS  Google Scholar 

  58. Everson SA, Kaplan GA, Goldberg DE, et al. Hopelessness and 4-year progression of carotid atherosclerosis. The Kuopio Ischemic Heart Disease Risk Factor Study. Arterioscler Thromb Vasc Biol 1997; 17 (8): 1490–1495.

    Article  PubMed  CAS  Google Scholar 

  59. Kubzansky LD, Kawachi I, Spiro A 3rd, et al. Is worrying bad for your heart? A prospective study of worry and coronary heart disease in the Normative Aging Study. Circulation 1997; 95 (4): 818–824.

    Article  PubMed  CAS  Google Scholar 

  60. Berkman LF, Leo-Summers L, Horwitz RI. Emotional support and survival after myocardial infarction. A prospective, population-based study of the elderly. Ann Intern Med 1992; 117 (12): 1003–1009.

    PubMed  CAS  Google Scholar 

  61. Olsen O. Impact of social network on cardiovascular mortality in middle aged Danish men. J Epidemiol Commun Health 1993; 47 (3): 176–180.

    Article  CAS  Google Scholar 

  62. Theorell T. The psycho-social environment, stress, and coronary heart disease. In: Marmot M, Elliot P, eds. Coronary Heart Disease Epidemiology: From Aetiology to Public Health. Oxford University Press, New York, 1992, pp. 256–273.

    Google Scholar 

  63. Smith T, Leon A, eds. Coronary Heart Disease: A Behavioral Perspective. Research Press, Champaign, IL. 1992.

    Google Scholar 

  64. van Dixhoorn J, Duivenvoorden HJ, Staal JA, et al. Cardiac events after myocardial infarction: possible effect of relaxation therapy. Eur Heart J 1987; 8 (11): 1210–1214.

    PubMed  CAS  Google Scholar 

  65. Falk E, Shah PK, Fuster V. Coronary plaque disruption. Circulation 1995; 92 (3): 657–671.

    Article  PubMed  CAS  Google Scholar 

  66. Lee RT, Libby P. The unstable atheroma. Arterioscler Thromb Vasc Biol 1997; 17: 1859–1867.

    Article  PubMed  CAS  Google Scholar 

  67. Levine GN, Keaney JF, Vita JA. Cholesterol reduction in cardiovascular disease. N Engl J Med 1995; 332 (8): 511–520.

    Article  Google Scholar 

  68. Superko HR, Krauss RM. Coronary artery disease regression: Convincing evidence for the benefit of aggressive lipoprotein management. Circulation 1994; 90: 1056–1069.

    Article  PubMed  CAS  Google Scholar 

  69. Treasure CB, Klein JL, Weintraub WS, et al. Beneficial effects of cholesterol-lowering therapy on the coronary endothelium in patients with coronary artery disease. N Engl J Med 1995; 332 (8): 481–493.

    Article  PubMed  CAS  Google Scholar 

  70. Anderson TJ, Meredith IT, Yeung AC, et al. The Effect of cholesterol-lowering and antioxidant therapy on endothelium-dependent coronary vasomotion. N Engl J Med 1995; 332 (8): 488–493.

    Article  PubMed  CAS  Google Scholar 

  71. Brown BG, Zhao XQ, Sacco DE, Albers J.J. Lipid lowering and plaque regression: new insights into prevention of plaque disruption and clinical events in coronary disease. Circulation 1993; 87 (6): 1781–1791.

    Article  PubMed  CAS  Google Scholar 

  72. Forrester JS, Shah PK. Lipid lowering versus revascularization: an idea whose time (for testing) has come. Circulation 1997; 96 (4): 1360–1362.

    Article  PubMed  CAS  Google Scholar 

  73. National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel II) (comment). Summary of the second report. JAMA 1993; 269 (23): 3015–3023.

    Article  Google Scholar 

  74. th Bethesda Conference September 14–15, 1995. Matching the intensity of risk factor management with the hazard for coronary disease events. J Am Coll Cardiol 1996; 27 (5): 957–1047.

    Google Scholar 

  75. Report of the Expert Committee on the diagnosis and classification of diabetes mellitus. Diabetes Care 1997; 20 (7): 1183–1197.

    Google Scholar 

  76. The sixth report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. Arch Intern Med 1997; 157 (21): 2413–2446.

    Article  Google Scholar 

  77. Recommendations of the Second Joint Task Force of European and Other Societies on Coronary Prevention. Prevention of coronary heart disease in clinical practice. Eur Heart J 1998; 339 (19): 1349–1357.

    Google Scholar 

  78. Pearson TA, Peters TD. The treatment gap in coronary artery disease and heart failure: community standards and the post-discharge patient. Am J Cardiol 1997; 80 (8B): 45H–52H.

    Article  PubMed  CAS  Google Scholar 

  79. Greenland P, Grundy S, Pasternak RC, Lenfant C. Problems on the pathway from risk assessment to risk reduction. Circulation 1998; 97: 1761–1762.

    Article  PubMed  CAS  Google Scholar 

  80. Giles WH, Anda RF, Jones DH, et al. Recent trends in the identification and treatment of high blood cholesterol by physicians: progress and missed opportunities. JAMA 1993; 269: 1133–1138.

    Article  PubMed  CAS  Google Scholar 

  81. Miller M, Konkel K, Fitzpatrick D, et al. Divergent reporting of coronary risk factors before coronary artery bypass surgery. Am J Cardiol 1995; 75: 736–737.

    Article  PubMed  CAS  Google Scholar 

  82. The Clinical Quality Improvement Network (CQIN) Investigators. Low incidence of assessment and modification of risk factors in acute care patients at high risk for cardiovascular events, particularly among females and the elderly. Am J Cardiol 1995; 76: 570–573.

    Google Scholar 

  83. Frame PS, Kowulich BA, Llewellyn AM. Improving physician compliance with a health maintenance protocol. J Fam Pract 1984; 19: 341–344.

    PubMed  CAS  Google Scholar 

  84. Frolkis J, Zyzanski S, Schwartz J, Suhan P. Physician non-compliance with the 1993 National Cholesterol Education Program (NCEP-ATPII) Guidelines. Circulation 1998; 98: 851–855.

    Article  PubMed  CAS  Google Scholar 

  85. Cohen MV, Byrne MJ, Levine B, et al. Low rate of treatment of hypercholesterolemia by cardiologist in patients with suspected and proven coronary artery disease. Circulation 1991; 83: 1294–1304.

    Article  PubMed  CAS  Google Scholar 

  86. Campbell NC, Thain J, Deans HG, et al. Secondary prevention in coronary heart disease: baseline survey of provision in general practice. Br J Med 1998; 316: 1430–1434.

    Article  CAS  Google Scholar 

  87. McCormick D, Gurwitz JH, Lessard D, et al. Use of aspirin, b-blockers, and lipid-lowering medications before recurrent acute myocardial infarction. Arch Intern Med 1999; 159: 561–567.

    Article  PubMed  CAS  Google Scholar 

  88. Schrott HG, Bittner V, Vittinghoff E, et al. Adherence to National Cholesterol Education Program treatment goals in postmenopausal women with heart disease. The Heart and Estrogen/Progestin Replacement Study (HRS). The HERS Research Group. JAMA 1997; 277: 1281–1286.

    Article  PubMed  CAS  Google Scholar 

  89. Marcelino JJ, Feingold KR. Inadequate treatment with HMG-CoA reductase inhibitors by health care providers. Am J Med 1996; 100: 605–610.

    Article  PubMed  CAS  Google Scholar 

  90. Hoerger TJ, Bala MV, Bray JW, et al. Treatment patterns and distribution of low-density lipoprotein cholesterol levels in treatment-eligible United States adults. Am J Cardiol 1998; 82: 61–65.

    Article  PubMed  CAS  Google Scholar 

  91. Ellerbeck EF, Jencks SF, Radford MJ, et al. Quality of care for Medicare patients with acute myocardial infarction. A four-state pilot study from the Cooperative Cardiovacular Project. JAMA 1995; 273: 1509–1514.

    Article  PubMed  CAS  Google Scholar 

  92. Berlowitz DR, Ash AS, Hickey EC, et al. Inadequate management of blood pressure in a hypertensive population. N Engl J Med 1998; 339 (27): 1957–1963.

    Article  PubMed  CAS  Google Scholar 

  93. Pearson T, McBride P, Houston-Miller N, Smith S. Task Force 8. Organization of Preventive Cardiology Service. J Am Coll Cardiol 1996; 27: 1039–1047.

    Article  PubMed  CAS  Google Scholar 

  94. Hill MN, Levine DM, Whelton PK. Awareness, use, and impact of the 1984 Joint National Committee consensus report on high blood pressure. Am J Public Health 1988; 78: 1190–1194.

    Article  PubMed  CAS  Google Scholar 

  95. Pommerenke FA, Weed DL. Physician compliance: improving skills in preventive medicine practices. Am Fam Physician 1991; 43: 560–568.

    PubMed  CAS  Google Scholar 

  96. Lomas J, Anderson GM, Domnick-Pierr, K, et al. Do practice guidelines guide practice? The effect of a consensus statement on the practice of physicians. N Engl J Med 1989; 321: 1306–1311.

    Article  PubMed  CAS  Google Scholar 

  97. Fix KN, Oberman A. Barriers to following National Cholesterol Educational Program Guidelines: An appraisal of poor physician compliance. Arch Intern Med 1992; 152: 2385–2387.

    Article  Google Scholar 

  98. McBride PE, Pacala JT, Dean J, Plane MB. Primary care residents and the management of hypercholesterolemia. Am J Prev Med 1990; 6: 71–76.

    PubMed  CAS  Google Scholar 

  99. Davis A, Thompson M, Oxman A, Haynes R. Changing physician performance. A systematic review of the effect of continuing medical education strategies. JAMA 1995; 274: 700–705.

    Article  PubMed  CAS  Google Scholar 

  100. Browner WS, Baron RB, Solkowitz S, et al. Physician management of hypercholesterolemia. A randomized trial of continuing medical education. West J Med 1994; 161: 572–578.

    PubMed  CAS  Google Scholar 

  101. Hill MN, Miller NH. Compliance enhancement. A call for multidisciplinary team approaches (editorial). Circulation 1996; 93: 4–6.

    Google Scholar 

  102. Sikand G, Kashyap ML, Yang I. Medical nutrition therapy lowers serum cholesterol and saves medication costs in men with hypercholesterolemia. J Am Diet Assoc 1998; 98: 889–894.

    Article  PubMed  CAS  Google Scholar 

  103. Shaffer J, Wexler LF. Reducing low-density lipoprotein cholesterol levels in an ambulatory care system. Arch Intern Med 1995; 155: 2330–2335.

    Article  PubMed  CAS  Google Scholar 

  104. Haskell WL, Alderman EL, Fair JM, et al. Effects of intensive multiple risk factor reduction on coronary atherosclerosis and clinical cardiac events in men and women with coronary artery disease: The Stanford Coronary Risk Intervention Project (SCRIP). Circulation 1994; 89: 975–990.

    Article  PubMed  CAS  Google Scholar 

  105. Harris DE, Record NB, Gipson GW, Pearson TA. Lipid lowering in a multidisciplinary clinic compared with primary physician management. Am J Cardiol 1998; 81: 929–933.

    Article  PubMed  CAS  Google Scholar 

  106. Schectman G, Wolff N, Byrd JC, et al. Physician extenders for cost-effective management of hypercholesterolemia. J Gen Intern Med 1996; 11: 277–286.

    Article  PubMed  CAS  Google Scholar 

  107. Schultz JF, Sheps SG. Management of patients with hypertension: A hypertension clinic model. Mayo Clin Proc 1994; 69: 997–999.

    Article  PubMed  CAS  Google Scholar 

  108. Reichgott MJ, Pearson S, Hill MN. The nurse practitioner’s role in complex patient management: hypertension. J Natl Med Assoc 1983; 75: 1197–1204.

    PubMed  CAS  Google Scholar 

  109. Weinberger M, Kirkman MS, Samsa GP, et al. A nurse-coordinated intervention for primary care patients with non-insulin-dependent diabetes mellitus: impact on glycemic control and health-related quality of life. J Gen Intern Med 1995; 10: 59–66.

    Article  PubMed  CAS  Google Scholar 

  110. Taylor CB, Houston-Miller N, Killen JD, DeBusk RF. Smoking cessation after acute myocardial infarction: effects of a nurse-managed intervention. Ann Intern Med 1990; 113: 118–123.

    PubMed  CAS  Google Scholar 

  111. Taylor CB, Miller NH, Herman S, et al. A nurse-managed smoking cessation program for hospitalized smokers. Am J Public Health 1996; 86: 1557–1560.

    Article  PubMed  CAS  Google Scholar 

  112. Miller NH, Smith PM, DeBusk RF, et al. Smoking cessation in hospitalized patients. Results of a randomized trial. Arch Intern Med 1997; 157: 409–415.

    Article  PubMed  CAS  Google Scholar 

  113. Lasater M. The effect of a nurse-managed CHF clinic on patient readmission and length of stay. Home Healthc Nurse 1996; 14: 351–356.

    Article  PubMed  CAS  Google Scholar 

  114. Blair TP, Bryant FJ, Bocuzzi S. Treating hyperlipidemia. J Cardiovasc Nurs 1988; 5: 55–57.

    Google Scholar 

  115. Bruce SL, Grove SK. The effect of a coronary artery risk evaluation program on serum lipid values and cardiovascular risk levels. Appl Nurs Res 1994; 7: 67–74.

    Article  PubMed  CAS  Google Scholar 

  116. Cofer LA. Aggressive cholesterol management: role of the lipid nurse specialist. Heart Lung 1997; 26: 337–344.

    Article  PubMed  CAS  Google Scholar 

  117. DeBusk RF, Miller NH, Superko HR, et al. A case-management system for coronary risk factor modification after acute myocardial infarction. Ann Intern Med 1994; 120: 721–729.

    PubMed  CAS  Google Scholar 

  118. Gerber J. Implementing quality assurance programs in multigroup practices for treating hypercholesterolemia in patients with coronary artery disease. Am J Cardiol 1997; 80 (8B): 57H–61H.

    Article  PubMed  CAS  Google Scholar 

  119. Dunn PJ, Ryan MJ Jr, Hiebert M. Strategic and cost effective role for preventive cardiology. J Cardiovasc Manag 1998; 9: 13–20.

    PubMed  CAS  Google Scholar 

  120. Dunn PJ, Superko HR, Halbrook M, et al. Setting up a preventive cardiology program in the real world. J Cardiovasc Manag 1998; 9: 16–21.

    PubMed  CAS  Google Scholar 

Download references

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2001 Springer Science+Business Media New York

About this chapter

Cite this chapter

Frolkis, J.P. (2001). A Multidisciplinary Model for Aggressive Risk Factor Control in Cardiovascular Disease. In: Foody, J.M. (eds) Preventive Cardiology. Contemporary Cardiology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-59259-001-8_17

Download citation

  • DOI: https://doi.org/10.1007/978-1-59259-001-8_17

  • Publisher Name: Humana Press, Totowa, NJ

  • Print ISBN: 978-1-4757-6241-9

  • Online ISBN: 978-1-59259-001-8

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics