Posted on Jan 11, 2020, 1 p.m.
Personalized and Precision Integrative Cardiovascular Medicine was written by Dr. Mark C. Houston and published by Wolters Kluwer Health. It encompasses functional cardiology, integrative medicine and metabolic medicine/cardiology, this unique reference offers an up-to-date, expert approach to heart wellness and treating the diseased heart and blood vessels. It provides today’s practitioners with insight into various treatment options and alternatives to pharmaceutical care and surgery, incorporating new scientific information on metabolic and integrative cardiovascular medicine from peer-reviewed articles, evidence based medicine and human clinical research as a foundation for practical clinical information.
Key features include:
- Covering functional cardiology, integrative medicine and metabolic medicine/cardiology in an expert, practical manner — ideally suited for practitioners who already incorporate integrative approaches in their practice, as well as more traditional clinicians who want to learn more about this growing area
- Reviewing pathophysiology, vascular biology and vascular aging, nutrition supplements and food sensitivities, testing and cardiovascular disease, hypertension, dyslipidemia, congestive heart failure, CV genomics, pharmacotherapy, special populations and more
- Helping clinicians develop a comprehensive prevention, management and treatment program to reduce the incidence of cardiovascular disease, targeting organ damage, morbidity and mortality • Ideal for cardiologists; fellows, naturopathic; osteopathic and chiropractic physicians; primary care and internal medicine providers; physician assistants; and nurse practitioners
The following is the editor’s introduction:
Despite aggressive guidelines and applications of advanced technology in cardiovascular (CV) medicine, the morbidity and mortality from coronary heart disease (CHD) is not declining worldwide. The traditional evaluation, prevention and treatment strategies for the top five CHD risk factors still result in a CHD gap. This means that about 50% of patients still have CHD or a myocardial infarction despite “normal” levels of these CHD risk factors as presently defined in the medical literature. There are important details within each of these top five risk factors that are not being optimally addressed or applied clinically for the prevention and treatment of CHD. This suggests that in all likelihood, that we have reached a limit in our capacity to reduce CHD with our traditional approaches in cardiovascular medicine.
An evolved strategy is now required. It is time to redefine cardiovascular medicine and institute a “new” cardiovascular medicine paradigm. This “new” CV medicine can be interpreted or defined by a variety of terms such as “functional”, “metabolic”, integrative”, “personalized”, “individualized” or “precision”. Regardless of the language that we choose, the salient point is that we need to modernize our approach if we expect to have a positive impact on CV disease.
Several key points need to be emphasized:
- The traditional risk factor-induced development of CHD emphasizes only on the top five CHD risk factors of hypertension, dyslipidemia, diabetes mellitus, obesity and smoking and their relationship to CV target organ damage. This strategy has severe limitations, specifically, the “cholesterol centric” approach.
- Recent results from clinical trials such as NAVIGATOR, ACCORD and ROADMAP suggest that we have reached a limit in terms of reducing CV events by solely controlling these top five CHD risk factors.
- New approaches, new testing, genetics and other ancillary treatments will be necessary if we hope to reduce CHD in the future.
- It is required that we understand, measure, prevent and treat the downstream mediators of the CHD risk factors. The CHD risk factors lead to specific mediators of vascular disease that create a “snowball-like” effect that may be difficult to interrupt or reverse once initiated. Therefore, early evaluation of the risk factors and mediators coupled with aggressive prevention and treatment programs is mandatory.
- The blood vessel has only three finite responses to an infinite number of insults. These responses are inflammation, oxidative stress, and immune vascular dysfunction and imbalance. This model of cardiovascular medicine is shown in the figure below.
- The blood vessel responds acutely to internal and external insults that are “correct and normal” but these chronic insults result in “a chronic exaggerated and dysregulated vascular dysfunction” with preclinical then clinical CVD due to maladaptation.
- The subsequent environmental- gene expression patterns produce downstream mediators that damage the arteries.
- Proper assessment, comprehension and treatment of the top five and numerous other CHD risk factors and the downstream mediators is required.
- The vascular system is the innocent bystander.
- CVD needs to be approached within a systems biology analysis and with the knowledge of the various organ system interconnections.
- Environmental-genetic interactions, CV genetics, nutrigenomics, proteomics and metabolomics provide important connections to advanced CV testing that will provide optimal individual responses.
Healthcare providers must provide quality, patient satisfaction and value that is patient-centered and provides the best cardiovascular outcomes at the lowest cost. We must move away from a cardiovascular disease orientation to a process and prevention orientation. The education and training of physicians to provide unique cardiovascular centers of excellence is paramount in this endeavor. This transformation of cardiovascular medicine will require much time and effort, but it must be done.
This cardiovascular textbook was written to address all of these concepts in the New Cardiovascular Medicine. Leading experts in their respective fields have written the most comprehensive chapters on cardiovascular medicine that are available, which will appeal to internists, family physicians, osteopathic physicians, naturopathic physicians, cardiologists and cardiovascular specialists and many others.
It has been my honor and privilege to serve as editor of this cardiovascular medicine textbook. I have learned much from my special colleagues. It is my hope that you will also learn and apply the information in this textbook and you will help to change the way that we practice cardiovascular medicine.
Personalized and Precision Integrative Cardiovascular Medicine was written by Dr. Mark C. Houston and published by Wolters Kluwer Health, using the promo code WKA502FF will save you 25% at their official website for any who may be interested in the book which also includes an enhanced eBook.
Mark Houston MD, MS, MSc ~ Editor
Mark C. Houston MD MS MSC FACP FAHA FASH FACN FAARM ABAARM DABC
Director, Hypertension Institute and Vascular Biology
Medical Director of the Division of Human Nutrition
Saint Thomas Medical Group, Saint Thomas Hospital, Nashville, Tennessee
Clinical, Instructor in the Department of Physical Therapy and Health Care Sciences at George Washington University (GWU) School of Medicine and Health Science
Associate Clinical Professor of Medicine Vanderbilt University Medical School (1990-2012)