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Ca rd iovascu la r Med ici ne 1.5 2 cups) and less than 1.5 cups ot vegetables (recommended, Epidemiology and 2-3 cups). The National Diabetes Prevention Program found Risk Factors that in persons at high risk for diabetes mellitus, interventions such as changes in diet, exercise, and weight loss of 5'7, to 7'1, Overuiew reduced the risk for developing diabetes by 58'2, but did not Cardiovascular disease (CVD) encompasses many conditions, reduce CVD events. including coronary artery disease (CAD), stroke, congenital Tobacco use is the leading preventable cause of disease, heart disease, rhythm disorders, subclinical atherosclerosis, disability, and death in the United States. and tobacco expo heart failure, valvular disease, venous disease, and peripheral sure is a significant risk factor for CVD. The prevalence of artery disease. CVD remains the leading cause of death in the tobacco use continues to decliner 16.7"/,' of men and 13.67, of United States; however, fiom 2004 to 2016, the age adjusted women were current smokers in 2015. The risk lor heart fail death rate fbr CVD fell by 22'l.. Despite this improvement, CVD ure and death fbr most former smokers is similar to that of' was responsible lbr nearly 31'/, ol all deaths in the United never smokers alter greater than 15 years of tobacco cessa States in 2016. Globally, a third of all deaths were attributed to tion. Smoking status should be assessed at every visit, and CVD in 2015. cessation counseling and pharmacologic therapy should be Nearly 507, of U.S. adults currently have some form of offered to active smokers (see I\4KSAP 19 General Internal CVD, including hypertension. Pre'u'alence increases with age, Medicine 1). :rnd more than 75'l, of persons aged 60 to 79 years have CVD. Psychosocial factors, including depression, anger, and Lifetime risk for CVD is estimated to be one in three for anxiety, are associated with worse cardiclvascular outcomes. women and two in three for men according to data from the Depression has been linked with higher risk for cardiovascular Framingham Heart Study. events. Psychosocial stressors also affect the course of'treat CVD was responsible for 4.8 million U.S. hospital dis ment and adherence to a healthy lifestyle after an event. charges in 2014. The estimated total cost of CVD fbr 2014 to Although it is important to detect and treat these disorders, 2015 was approxin.rately $350 billion. The projected total cost there is no evidence that such detection and treatment impacts of CVD between 2015 and 2035 is estimated to remain stable cardiovascular risk itself. lor most persons but to increase sharply for adults aged 65 years or older. Dyslipidemia An estimated 6.2 million U.S. adults older than 20 years Twelve percent of adults older than age 20 years have total l.rave a diagnosis of heart lailure, a final common pathway for cholesterol levels greater than 240 mgldL (6.22 mmol/L). many cardiovascular conditions. The prevalence of'heart fail Elevated semm cholesterol levels are associated with increased ure is projected to increase by 46"/,, between 2012 and 2030. cardiovascular risk, and reducing cholesterol le'uels has been shown to lower overall risk. Elevated LDL cholesterol and low HDL cholesterol levels also are independently associated witlr Risk Factors for increased risk fbr CVD. Lipid lowering therapies lor primary Ca rd iovascu la r Disease and secondary prevention of CVD are discussed in MKSAP 19 Lifestyle General lnternal Medicine 1. The selen metrics of ideal cardiovascular health are optimal lipid, btood pressure, and glucose levels; healthy dieti appro Hypertension priate energy intake; physical activity; and avoidance of Hypertension (blood pressure >130/80 mm Hg) alfects approx- tobacco; however. very few people meet these metrics. imately 46% of persons aged 20 years or older. Before age Promotion of a healthy lifestyle throughout life remains the 45 years, the prevalence of hypertension is higher in men than most inlportant way to prevent atherosclerotic CVD. in womenr however, after age 65 years, the prevalence is higher Sedentary lifestyle, poor diet, and obesity all contribute in women. The population attributable risk of hypertension for to increased cardiovascular risk. According to the CDC, only stroke is 17.9"1,. Treatment of hypertension reduces risk for 22.5'X, of aclults meet aerobic and strengthening recommen stroke, heart failure, and kidney disease. Early recognition and datior.rs. Average daily lruit and vegetable consumption in effective management of hypertension could reduce CVD mor the United States is less than 1 cup of fruit (recommended, tality by 30.4% among men and 38.0'X, among women.

1.5 2 cups) and less than 1.5 cups ot vegetables (recommended, Epidemiology and 2-3 cups). The National Diabetes Prevention Program found Risk Factors that in persons at high risk for diabetes mellitus, interventions such as changes in diet, exercise, and weight loss of 5'7, to 7'1, Overuiew reduced the risk for developing diabetes by 58'2, but did not Cardiovascular disease (CVD) encompasses many conditions, reduce CVD events. including coronary artery disease (CAD), stroke, congenital Tobacco use is the leading preventable cause of disease, heart disease, rhythm disorders, subclinical atherosclerosis, disability, and death in the United States. and tobacco expo heart failure, valvular disease, venous disease, and peripheral sure is a significant risk factor for CVD. The prevalence of artery disease. CVD remains the leading cause of death in the tobacco use continues to decliner 16.7"/,' of men and 13.67, of United States; however, fiom 2004 to 2016, the age adjusted women were current smokers in 2015. The risk lor heart fail death rate fbr CVD fell by 22'l.. Despite this improvement, CVD ure and death fbr most former smokers is similar to that of' was responsible lbr nearly 31'/, ol all deaths in the United never smokers alter greater than 15 years of tobacco cessa States in 2016. Globally, a third of all deaths were attributed to tion. Smoking status should be assessed at every visit, and CVD in 2015. cessation counseling and pharmacologic therapy should be Nearly 507, of U.S. adults currently have some form of offered to active smokers (see I\4KSAP 19 General Internal CVD, including hypertension. Pre'u'alence increases with age, Medicine 1). :rnd more than 75'l, of persons aged 60 to 79 years have CVD. Psychosocial factors, including depression, anger, and Lifetime risk for CVD is estimated to be one in three for anxiety, are associated with worse cardiclvascular outcomes. women and two in three for men according to data from the Depression has been linked with higher risk for cardiovascular Framingham Heart Study. events. Psychosocial stressors also affect the course of'treat CVD was responsible for 4.8 million U.S. hospital dis ment and adherence to a healthy lifestyle after an event. charges in 2014. The estimated total cost of CVD fbr 2014 to Although it is important to detect and treat these disorders, 2015 was approxin.rately $350 billion. The projected total cost there is no evidence that such detection and treatment impacts of CVD between 2015 and 2035 is estimated to remain stable cardiovascular risk itself. lor most persons but to increase sharply for adults aged 65 years or older. Dyslipidemia An estimated 6.2 million U.S. adults older than 20 years Twelve percent of adults older than age 20 years have total l.rave a diagnosis of heart lailure, a final common pathway for cholesterol levels greater than 240 mgldL (6.22 mmol/L). many cardiovascular conditions. The prevalence of'heart fail Elevated semm cholesterol levels are associated with increased ure is projected to increase by 46"/,, between 2012 and 2030. cardiovascular risk, and reducing cholesterol le'uels has been shown to lower overall risk. Elevated LDL cholesterol and low HDL cholesterol levels also are independently associated witlr Risk Factors for increased risk fbr CVD. Lipid lowering therapies lor primary Ca rd iovascu la r Disease and secondary prevention of CVD are discussed in MKSAP 19 Lifestyle General lnternal Medicine 1. The selen metrics of ideal cardiovascular health are optimal lipid, btood pressure, and glucose levels; healthy dieti appro Hypertension priate energy intake; physical activity; and avoidance of Hypertension (blood pressure >130/80 mm Hg) alfects approx- tobacco; however. very few people meet these metrics. imately 46% of persons aged 20 years or older. Before age Promotion of a healthy lifestyle throughout life remains the 45 years, the prevalence of hypertension is higher in men than most inlportant way to prevent atherosclerotic CVD. in womenr however, after age 65 years, the prevalence is higher Sedentary lifestyle, poor diet, and obesity all contribute in women. The population attributable risk of hypertension for to increased cardiovascular risk. According to the CDC, only stroke is 17.9"1,. Treatment of hypertension reduces risk for 22.5'X, of aclults meet aerobic and strengthening recommen stroke, heart failure, and kidney disease. Early recognition and datior.rs. Average daily lruit and vegetable consumption in effective management of hypertension could reduce CVD mor the United States is less than 1 cup of fruit (recommended, tality by 30.4% among men and 38.0'X, among women. 1