Leading cardiology experts gathered February 7-9, 2008 in Coral Gables, Florida, for the Sixth Annual Comprehensive Symposium on Cardiovascular Disease Prevention. The presenters explored the latest research on the prevention and management of cardiovascular disorders using medical therapy, diet, exercise, mind-body medicine, and careful monitoring of risk factors.

Symposium director Michael Ozner, MD, medical director of Baptist Health South Florida’s Center for Prevention and Wellness and author of the Miami Mediterranean Diet, highlighted the importance of healthy lifestyle and preventive action in tackling the nation’s leading killer, cardiovascular disease. For decades, Dr. Ozner has advocated aggressive prevention over aggressive intervention.

Keynote speaker Peter Libby, MD, of Harvard University explored the intimate relationship between inflammation and atherosclerosis, noting that most myocardial infarctions occur when inflammation promotes the rupture of vulnerable plaque. Smoking cessation, healthy diet, physical activity, and lipid lowering help stabilize atherosclerotic plaque so it is less likely to rupture.

Among other highlights of the symposium:

• Antonio Gotto, MD, DPhil, of Cornell University discussed that lowering low-density lipoprotein (LDL) levels is essential for cardiovascular health, noting that no threshold has been identified below which risk vanishes.

• Paul Ridker, MD, MPH, of Harvard University cited research showing that cardiovascular risk is lowest when LDL is <70 mg/dL and the inflammatory marker, high sensitivity C-reactive protein (hs-CRP), is <2 mg/L.

• William Cromwell, MD, noted that even individuals who have low levels of total LDL (<70 mg/dL) can have an excess of LDL particle number, which increases their risk. Customized testing is necessary to uncover this hidden danger.

• Insulin resistance dramatically increases heart disease risk, explained Gerald Reaven, MD, emeritus professor of medicine at Stanford University. Elevated triglycerides, low HDL, and high blood pressure can help physicians identify patients who are likely to be insulin-resistant.

• Lowering systolic blood pressure produces a greater reduction in coronary heart disease and stroke risk than does lowering LDL levels, stressed Joseph Izzo, MD, of the State University of New York at Buffalo.

• Aspirin therapy following a heart attack offers both short- and long-term protection against future heart attack and stroke, yet is widely underutilized, noted the University of Miami’s Charles Hennekens, MD.

• William Boden, MD, of the University of Buffalo discussed research that showed the use of a coronary stent plus optimal medical therapy was no more effective than optimal medical therapy alone in preventing death or cardiovascular events in patients with coronary artery blockages and stable coronary heart disease.

• While elevated homocysteine may predict a higher rate of cardiovascular and non-cardiovascular mortality, clinical trials have not yet conclusively demonstrated that lowering homocysteine reduces risk, according to Theodore Feldman, MD, of the University of Miami.

• Conventional risk assessment fails to identify 70% of those who will suffer from a primary cardiac event, according to Harvey Hecht, MD. Measuring coronary artery calcium, a marker for atherosclerotic plaque burden, could detect 90% of those who will experience a future event.

• Cardiovascular disease is the leading cause of death in women, striking one in two. Prevention is essential to offset this overlooked killer, noted Nanette Wenger, MD, of Emory University.

• Exercise is essential for cardiovascular disease prevention, stressed Tim Church, MD, MPH, PhD, of Louisiana State University. Even as little as 10 minutes per day confers benefits, though more is better.

• Stress management is essential to cardiovascular health. A simple technique called the relaxation response can help manage hypertension and cardiac arrhythmia, according to Harvard University’s Herbert Benson, MD.

• Overall, the symposium’s message was that the study of heart disease continues to evolve and advance. The wealth of information gleaned from the Cardiovascular Disease Prevention Symposium will no doubt help health care providers give better care for the cardiovascular health of their patients.

—Elizabeth Wagner, ND