Eight-Year Outcomes of a Program for Early Prevention of Cardiovascular Events

Du, Feng; Esperat, M. Christina; Doneen, Amy L.; Bale, Bradley Field; Song, Huaxin; Green, Alexia E.

doi:10.1097/jcn.0000000000000141

Cited by 6 publications

(10 citation statements)

References 34 publications

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“…Free Hb is routinely released into tissues as result of intravascular hemolysis following the destruction and recycling of senescent red blood cells (RBC), this process occurs at a rate of 2 × 10 6 RBC per second ( 27 , 28 ). Severe complications result from intravascular hemolysis when accompanied by pathologies such as cancer, infectious disease, trauma, and diabetes ( 29 , 30 ). Haptoglobin binds to Hb to form strong non-covalent complexes that facilitate removal via CD163 receptor-mediated endocytosis on hepatocytes, Kupffer cells and tissue macrophages through the reticuloendothelial system ( 31 – 34 ).…”

Section: Haptoglobin Basic Sciencementioning

confidence: 99%

Precision Healthcare of Type 2 Diabetic Patients Through Implementation of Haptoglobin Genotyping

Bale

Doneen

Vigerust

2018

Front. Cardiovasc. Med.

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It is well-recognized that there is a need for medicine to migrate to a platform of delivering preventative care based on an individual's genetic make-up. The US National Research Council, the National Institute of Health and the American Heart Association all support the concept of utilizing genomic information to enhance the clinical management of patients. It is believed this type of precision healthcare will revolutionize health management. This current attitude of some of the most respected institutes in healthcare sets the stage for the utilization of the haptoglobin (Hp) genotype to guide precision management in type 2 diabetics (DM). There are three main Hp genotypes: 1-1, 2-1, 2-2. The Hp genotype has been studied extensively in (DM) and from the accumulated data it is clear that Hp should be considered in all DM patients as an additional independent cardiovascular disease (CVD) risk factor. In DM patients Hp2-2 generates five times increased risk of CVD compared to Hp1-1 and three times increased risk compared to Hp2-1. Data has also shown that carrying the Hp2-2 gene in DM compared to carrying an Hp1-1 genotype can increase the risk the microvascular complications of nephropathy and retinopathy. In addition, the Hp2-2 gene enhances post percutaneous coronary intervention (PCI) complications such as, in stent restenosis and need for additional revascularization during the first-year post PCI. Studies have demonstrated significant mitigation of CVD risk in Hp2-2 DM patients with administration of vitamin E and maintaining tight glycemic control. CVD is the leading cause of death and disability in DM as well-representing a huge financial burden. As such, evaluating the Hp genotype in DM patients can enhance the predictability and management of CVD risk.

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Section: Haptoglobin Basic Sciencementioning

confidence: 99%

Precision Healthcare of Type 2 Diabetic Patients Through Implementation of Haptoglobin Genotyping

Bale

Doneen

Vigerust

2018

Front. Cardiovasc. Med.

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“…Cardiovascular prevention programs have clinical tests to identify and monitor subclinical plaque in its asymptomatic form (18,34). Carotid intima-media thickness (cIMT) testing via B-mode ultrasound is an inexpensive method that is safe and simple for evaluating CV risk by measuring the combined thickness of the intimal and medial layers of the artery wall.…”

Section: Discussionmentioning

confidence: 99%

“…The natural progression of vascular disease can begin in early adolescence as fatty streaks within the arterial wall (16). At the same time, it is important to realize that atherosclerosis and CVD are not unavoidable consequences of aging and there are occasions to intervene early in the disease progression and halt the atherosclerotic disease process (17,18). Gradual, often silent expansion of extant lesions may eventually limit arterial blood flow.…”

Section: Binary To Ternary Classificationmentioning

confidence: 99%

Cardiovascular Prevention: Migrating From a Binary to a Ternary Classification

Doneen

Bale

Vigerust

et al. 2020

Front. Cardiovasc. Med.

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Migrating from a binary approach to risk assessment to a ternary model of disease identification allows for individualized, optimal disease management. Redefining the disease/inflammatory approach has been proven to identify, stabilize, and regress atherosclerosis while adding understanding to the progression of vascular disease. Our previously published results show the beneficial effect of comprehensive, evidence-based management on subclinical atherosclerosis and vulnerable plaque. We argue that this approach does not mitigate the value of utilizing standard risk factor identification, but rather augments it for the benefit of the individual patient.

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“…DIRECT utilizes the Bale/Doneen disease/ inflammatory approach to risk assessment, which has been proven to cause vascular disease regression [22]. The DIRECT program utilizes the assessment aspects of the Bale/Doneen Method for the CE portion of the course.…”

Section: Identifying Asymptomatic Vascular Diseasementioning

confidence: 99%

The Direct Program: A Disease/Inflammatory vs Risk Factor Evaluation Cardiovascular Testing Program

Doneen¹

2014

Int J Nurs Clin Pract

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The DIRECT Program-Disease/Inflammation vs Risk Evaluation Cardiovascular Testing Program (DIRECT) is a continuing education program developed and delivered to nurse practitioners that addresses the gap in practice between a risk factor approach to cardiovascular assessment and the scientific evidence for a disease/inflammatory approach. The purpose of this article is to describe the DIRECT program, identify the gaps in current guidelines and then describe the process by which the DIRECT program was tested with a group of practicing nurse practitioners.The activity was created after a systemic review of the current clinical guidelines for cardiovascular disease risk assessment presented a comprehensive review of the evidence supporting a disease/inflammatory approach to cardiovascular disease prevention. Following the delivery of the course content, the nurse practitioners were given ample time to discuss the information and they were evaluated for course knowledge and queried about intent to apply the information to practice. Clinical decision making of nurse practitioners completing this activity was assessed using clinical case application of both models (disease and risk). The aim of this program was to promote a health-screening model for family practice nurse practitioners with the goal of preventing heart attacks and ischemic strokes in primary care patients, aimed at quality improvement of care and the application of a new care model for nursing practice. This program celebrates the core foundational calling for doctoral prepared nurses to practice the most advanced level of nursing practice, which involves the application of current scientific knowledge that transcends specialties for the benefit of optimal health for the patient. The results revealed a statistically significant indication that the nurse practitioners felt that DIRECT would enhance their current practice and they felt a disease/inflammatory approach to cardiovascular disease risk assessment was more effective than the standard risk factor model currently in the standard of care.

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Eight-Year Outcomes of a Program for Early Prevention of Cardiovascular Events

Abstract: The current findings suggest that the Bale/Doneen Method is effective in generating a positive effect on the atherosclerotic disease process by achieving regression of disease in the carotid arteries.

Cited by 6 publications

References 34 publications

Precision Healthcare of Type 2 Diabetic Patients Through Implementation of Haptoglobin Genotyping

Precision Healthcare of Type 2 Diabetic Patients Through Implementation of Haptoglobin Genotyping

Cardiovascular Prevention: Migrating From a Binary to a Ternary Classification

The Direct Program: A Disease/Inflammatory vs Risk Factor Evaluation Cardiovascular Testing Program

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