- 1 Prevention
- 1.1 Exercise
- 1.2 Preventive diets
- 1.3 Alcohol
- 1.4 Aspirin
- 1.5 Anticholesteremic agents
- 1.6 Antioxidant vitamins
- 1.7 Omega-3 fatty acids (fish oil)
- 1.8 Homocysteine lowering
- 1.9 Vitamin D
- 1.10 Angiotensin-converting enzyme inhibitors
- 1.11 Evidence table
- 2 Prognosis
- 3 References
In medicine, vascular disease is "pathological processes involving any of the blood vessels in the cardiac or peripheral circulation. They include diseases of arteries; veins; and rest of the vasculature system in the body." Examples of vascular diseases include coronary heart disease, cerebrovascular disorders, and peripheral vascular disease.
Separate to the question of the benefits of exercise; it is unclear whether doctors should spend time counseling patients to exercise. The U.S. Preventive Services Task Force (USPSTF), based on a systematic review of randomized controlled trials, found 'insufficient evidence' to recommend that doctors counsel patients on exercise. However, the American Heart Association, based on a non-systematic review, recommends that doctors counsel patients on exercise 
Dietary changes can potentially lead to large changes in the cholesterol.
The World Health Organization (WHO) recommends "low to moderate alcohol intake" to reduce risk of coronary heart disease.
Clinical practice guidelines
|Age||10 year CHD risk||Age||10 year stroke risk|
|45-59 years||≥ 4%||50-59 years||≥ 3%|
|60-69 years||≥ 9%||60-69 years||≥ 8%|
|70-79 years||≥ 12%||70-79 years||≥ 11%|
- If on NSAID: multiple rates by 4
- If prior PUD: multiply rates by 2 to 3
The European Society of Cardiology has addressed this topic and concluded, "."
The Antithrombotic Trialists' (ATT) Collaboration has conducted a collaborative meta-analysis of individual participant data and concluded that aspirin reduced serious vascular events with a rate ratio [RR] 0·88 (95% CI 0·82–0·94]). However, the benefit was not found in patients with projected 5 year risk greater than 10%.
Aspirin, in doses of less than 75 to 81 mg/d, can reduce the incidence of cardiovascular events. In most cases the net benefit is less than 1 patient among 100. A more recent meta-analysis suggests the benefit is not clear, especially for patients on statins. An accompanying editorial, offers a cost-benefit analysis that recommends aspirin if the 10 year risk of vascular disease is at least 30%.
The benefit for diabetics is not clear.
Antioxidant vitamins are not beneficial.
Omega-3 fatty acids (fish oil)
A meta-analysis concluded that lowering homocysteine with folic acid and other supplements may reduce stroke. However, the two largest randomized controlled trials included in the meta-analysis had conflicting results. Lonn reported positive results; whereas the trial by Toole was negative.
Angiotensin-converting enzyme inhibitors
The Heart Outcomes Prevention Evaluation (HOPE) study suggested that the angiotensin-converting enzyme inhibitor ramipril could reduce vascular disease and mortality among patients at increased risk. This effect was thought to be independent of control of blood pressure. However, subsequent studies have shown this result was more likely due to the administration of ramipril at night and recording blood pressures during the day when the least effect of ramipril was present.
|Study type||Relative risk ratio or odds ratio|
for all-cause mortality
|Aspirin|| Systematic review of 6 RCTs through 2005
(Does not include negative JPAD trial)
| Men OR=0.93|
|Statin|| Systematic review of 7 RCTs through 2005
(Does not include positive Jupiter or negative GISSI-HF trials)
|Fish oil|| Systematic review of 12 RCTs through 2006
(Does not include positive GISSI-HF)
|No systematic review reported a significant decrease in mortality.|
Many new biomarkers have been studied for their ability to improvement upon prediction based on traditional risk factors.
|Framingham plus ankle brachial index||10-year total mortality, cardiovascular mortality, and major coronary event||Total reclassification: 19% (men); 36% (women)|
|Traditional risk factors (Framingham) plus coronary calcium score||coronary heart disease events||Net reclassification improvement 25%|
|Traditional risk factors (Framingham) plus c-reactive protein||"myocardial infarction and CHD-related death"||Net reclassification improvement = 12%|
|Traditional risk factors plus c-reactive protein and family history of MI before age 60 (Reynolds Score)||All cardiovascular events||Net reclassification improvement = 8% (in men)|
Regarding coronary heart disease, about 3/4 of its prognosis is due to three risk factors: hypercholesterolemia (total cholesterol > 182 mg/dL [4.71 mmol/L]), hypertension (diastolic blood pressure > 90 mm Hg), and cigarette smoking.
The Framingham risk uses clinical risk factors that are combined in an equation developed from the Framingham Heart Study to calculate prognosis. An online calculator is available at http://hp2010.nhlbihin.net/atpiii/calculator.asp.
Although many studies report better models than the Framingham model, the methods of these studies may not be adequate.
Ankle brachial index (ABI)
The Reynolds score has been proposed as an improvement to the Framingham risk by incorporating the c-reactive protein. The score has been validated in the Women's Genome Health Study. An online calculator is at http://www.reynoldsriskscore.org/.
C-reactive protein (CRP)
The CRP is part of the Reynolds score.
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