Pressing forward with primary prevention for CVD

February is American Heart Month, and while cardiovascular disease remains the number one cause of death in the U.S., updated data from the American Heart Association show that deaths from both stroke and heart disease decreased from 2008 to 2018. In addition, recent news and research have offered an updated road map for physicians on how to work with patients to maintain and perhaps even improve on these gains. Our story looks at new dietary guidance, calculation of cardiovascular risk, recommendations on statin and aspirin use, and more.

Three other stories in this issue offer advice on managing mental health symptoms, especially among older adults, especially during a pandemic. Our story looks at the potential side effects of benzodiazepines. The drug class has been linked to serious adverse events and to possible dependence, with elderly patients at higher risk, leading the FDA to revise the label in September 2020. For older patients struggling with anxiety, insomnia, and loneliness, lifestyle interventions, psychotherapy, and alternative medications may be a better, and safer, bet, experts say.

Depression is another common problem among the elderly, but it's not an inevitable consequence of aging, nor is it untreatable, according to our story. Part of the job of physicians is sorting out when a physical symptom points to a mental health diagnosis and remaining alert to the possibility of situational depression, which can be triggered by a life change such as the loss of a partner. Read our story for more.

Then, turn to the Success Story to learn how a trial designed to offer medically tailored meals and social connection became a successful intervention aimed at combating loneliness in housebound adults during COVID-19. Researchers at the University of Texas at Austin leveraged their existing partnership with a local Meals on Wheels chapter to offer patients support via phone calls with trained lay volunteers, yielding improvements not just in loneliness but also in depression and anxiety.

For an update on perioperative medicine, read a Q&A with Steven L. Cohn, MD, MACP, who edited the recently published book "Decision Making in Perioperative Medicine: Clinical Pearls." And speaking of pearls, our Pearls from I.M. Peers series continues, with Maria (Gaby) Frank, MD, FACP, a hospitalist at Denver Health Hospital Authority in Colorado, discussing the importance of avoiding anchoring in diagnosis.

How do you approach CVD prevention in your practice? Let us know at immatters@acponline.org.

Sincerely,

Jennifer Kearney-Strouse
Executive Editor