The Medical clinics of North America
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This review highlights the key components of a heart-healthy diet and presents an evidence-based overview of recent research. Diets that increase plant-based food sources and healthy unsaturated fats consumption and limit foods that are processed and/or high in sodium, refined sugar, and saturated fat are recommended. Dietary modification can be supplemented with lifestyle-based therapies (eg, exercise, time-restricted eating) to maximize clinical benefit and achieve the "cardiometabolic jackpot." Physicians should take into account cultural preferences, affordability and accessibility of foods, and their patients' cultural values or expectations when recommending dietary interventions.
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Hypertension is a major cause of cardiovascular morbidity and mortality globally. Many patients with hypertension have secondary causes of hypertension that merit further evaluation. ⋯ However, secondary hypertension is often underrecognized. The goal of this review is to highlight optimal approaches to the diagnosis and management of common causes of secondary hypertension, including primary aldosteronism, renovascular hypertension, obstructive sleep apnea, and drug-induced hypertension.
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Med. Clin. North Am. · Mar 2022
ReviewCardiovascular Genetics: The Role of Genetics in Predicting Risk.
Many cardiovascular disorders have underlying genetic causes. Clinical genetic testing for cardiovascular disease has become widely available and can be useful for diagnosis, management, and cascade screening in selected conditions and circumstances. This article gives an overview of the current state of genetic testing in inherited cardiovascular conditions, who can benefit from it, and the associated challenges.
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Med. Clin. North Am. · Mar 2022
ReviewGenetic Lipid Disorders Associated with Atherosclerotic Cardiovascular Disease: Molecular Basis to Clinical Diagnosis and Epidemiologic Burden.
Genetic lipid disorders, ranging from common dyslipidemias such as familial hypercholesterolemia, lipoprotein (a), and familial combined hyperlipidemia to rare disorders including familial chylomicronemia syndrome and inherited hypoalphalipoproteinemias (ie, Tangier and fish eye diseases), affect millions of individuals in the United States and tens of millions around the world and are often undiagnosed in the general population. Clinicians should take into consideration the potential of inherited lipid disorders or syndromes when severe derangements in lipid parameters are observed. Patients' combined genotype and phenotype should be evaluated in conjunction with a host of environmental factors impacting their risk of atherosclerotic cardiovascular disease.
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One's total atherosclerotic plaque burden is related to his or her cumulative exposure to low-density lipoprotein cholesterol (LDL-C) and other apoB-containing lipoproteins. Long-term exposure to lower LDL-C levels is associated with a lower risk of cardiovascular events compared with shorter term exposure to lower LDL-C. New lipid-reducing agents have been able to reduce LDL-C to previously unseen levels, showing efficacy in safely decreasing rates of atherosclerotic cardiovascular disease in primary and secondary prevention populations. To date, an LDL-C level less than which there is no clinical benefit has not yet been identified.