Cardiovascular Prevention: Migrating From a Binary to a Ternary Classification

Doneen, Amy L.; Bale, Bradley Field; Vigerust, David J.; Leimgruber, Pierre P.

doi:10.3389/fcvm.2020.00092

Cited by 2 publications

(3 citation statements)

References 57 publications

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“…The current binary ASCVD risk classification system defines primary prevention as preventing adverse ASCVD events in individuals with no history of a MACE and secondary prevention as preventing recurrent adverse ASCVD events in individuals who have previously suffered a MACE. Doneen et al (2020) proposed a new ternary classification system to enhance individualized care and risk reduction. Under this classification system, primary prevention includes individuals without existing ASCVD (Lamon & Hajjar, 2008).…”

Section: Treating An N Of 1: Population Versus Precision Health Carementioning

confidence: 99%

“…This approach aims to reduce arterial inflammation and stabilize plaque to prevent progression and adverse ASCVD events. Finally, tertiary prevention includes individuals with a history of MACE, with the treatment goal focusing on stabilizing plaque, reducing arterial inflammation, and preventing future events (Doneen et al, 2020). This paradigm change requires transforming one's mental model and approach to the individual patient's risk assessment.…”

Section: Treating An N Of 1: Population Versus Precision Health Carementioning

confidence: 99%

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Clinical utility of inflammatory and genetic biomarkers for cardiovascular disease prevention, categorization, and treatment

Mewborn

Wright²,

Wicks

2023

J Am Assoc Nurse Pract

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The complex interplay of increased atherogenic lipoproteins, inflammation, and immune activation hallmarks the pathogenesis of atherosclerotic cardiovascular disease (ASCVD). Atherosclerotic cardiovascular disease remains a leading cause of death, yet risk estimator tools lack comprehensiveness for genetic/inflammatory biomarkers associated with ASCVD. Unexplained ASCVD risk necessitates a better understanding of primary, secondary, and tertiary prevention variables. This article discusses the clinical utility of genetic and inflammatory biomarkers for ASCVD risk prediction, management, treatment, and recategorization into primary, secondary, and tertiary prevention. Furthermore, nurse practitioners (NPs) should use a ternary prevention classification system instead of the current binary system to mitigate risk in the large group of patients with subclinical ASCVD. High-sensitivity C-reactive protein (hs-CRP)—linearly associated with ASCVD—and lipoprotein-associated phospholipase-A2 (Lp-PLA2) and myeloperoxidase (MPO), both associated with plaque vulnerability/rupture, are inflammatory biomarkers. Elevated hs-CRP, MPO, and Lp-PLA2 treatment requires addressing root causes of elevation (e.g., obesity, insulin resistance, tobacco use, gingival disease, and chronic autoimmune/infectious conditions). In addition, haptoglobin (Hp) phenotype determines the antioxidant potential of Hp. Haptoglobin phenotype, a root cause of ASCVD, is a one-time test. Individuals with Hp 2-2 should adopt a gluten-free diet to reduce endothelial and intestinal inflammation. Nurse practitioners should use stricter glycemic goals (hemoglobin A1c ≤6.5%) and add daily vitamin E if this group has type 2 diabetes. Genetic/inflammatory biomarkers should be used to better predict ASCVD risk and tailor primary, secondary, and tertiary prevention treatment. Clinical use of these biomarkers reaches beyond the standard of care to reduce residual ASCVD risk.

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Section: Treating An N Of 1: Population Versus Precision Health Carementioning

confidence: 99%

Section: Treating An N Of 1: Population Versus Precision Health Carementioning

confidence: 99%

Clinical utility of inflammatory and genetic biomarkers for cardiovascular disease prevention, categorization, and treatment

Mewborn

Wright²,

Wicks

2023

J Am Assoc Nurse Pract

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“…Tertiary prevention was given to subjects who proved they had arterial disease with interventions or events. This classification aided therapy decisions such as low-dose aspirin ( 270 ). The high degree of management compliance is partially attributed to the patient's visualization of the plaque ( 271 ).…”

Section: Translation To Clinical Practicementioning

confidence: 99%

The critical issue linking lipids and inflammation: Clinical utility of stopping oxidative stress

Bale

Doneen

Leimgruber

et al. 2022

Front. Cardiovasc. Med.

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The formation of an atheroma begins when lipoproteins become trapped in the intima. Entrapped lipoproteins become oxidized and activate the innate immune system. This immunity represents the primary association between lipids and inflammation. When the trapping continues, the link between lipids and inflammation becomes chronic and detrimental, resulting in atherosclerosis. When entrapment ceases, the association between lipids and inflammation is temporary and healthy, and the atherogenic process halts. Therefore, the link between lipids and inflammation depends upon lipoprotein retention in the intima. The entrapment is due to electrostatic forces uniting apolipoprotein B to polysaccharide chains on intimal proteoglycans. The genetic transformation of contractile smooth muscle cells in the media into migratory secretory smooth muscle cells produces the intimal proteoglycans. The protein, platelet-derived growth factor produced by activated platelets, is the primary stimulus for this genetic change. Oxidative stress is the main stimulus to activate platelets. Therefore, minimizing oxidative stress would significantly reduce the retention of lipoproteins. Less entrapment decreases the association between lipids and inflammation. More importantly, it would halt atherogenesis. This review will analyze oxidative stress as the critical link between lipids, inflammation, and the pathogenesis of atherosclerosis. Through this perspective, we will discuss stopping oxidative stress to disrupt a harmful association between lipids and inflammation. Numerous therapeutic options will be discussed to mitigate oxidative stress. This paper will add a new meaning to the Morse code distress signal SOS-stopping oxidative stress.

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Cardiovascular Prevention: Migrating From a Binary to a Ternary Classification

Cited by 2 publications

References 57 publications

Clinical utility of inflammatory and genetic biomarkers for cardiovascular disease prevention, categorization, and treatment

Clinical utility of inflammatory and genetic biomarkers for cardiovascular disease prevention, categorization, and treatment

The critical issue linking lipids and inflammation: Clinical utility of stopping oxidative stress

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