About IMPACT:

Innovative Medical Practices Advancing Cardiovascular Therapy

Cardiovascular disease (CVD) is of major clinical, public health, and economic importance. Nearly 80 million people are estimated to suffer from CVD in the United States alone, and it is estimated that CVD accounts for approximately 36% of deaths in the US.¹ CVD represents a spectrum of ailments affecting the heart and arterial system. Both the incidence and prevalence of CVD have significantly increased the urgent need for more effective strategies for its prevention and treatment.

Among the ailments constituting CVD are hypertension and coronary heart disease (CHD), both of which are underlying pathologies of heart failure. Hypertension is a powerful independent predictor of premature death and disability from cardiovascular complications and death from all causes. In the United States alone, an estimated 72 million persons are considered to have hypertension or are taking antihypertensive medications. ¹

Neurohormonal changes activated in hypertension and heart failure include the renin-angiotensin-aldosterone-system (RAAS) and the sympathetic nervous system (SNS). RAAS has been widely researched as a primary cause for CVD and recent therapeutic advances have brought exciting new treatment options for patients with hypertension. The SNS has gained considerable attention with data supporting the blockade of beta-1 receptors in improving survival in heart failure. Many clinical trials have contributed to a more complete understanding of ways that physicians can improve hypertension and heart failure management with a focus on both RAAS and SNS blockade.

CHD, the leading cause of death in the US¹, results from atherosclerosis in one or more coronary artery. Atherosclerosis is a narrowing of the coronary artery leading to insufficient blood flow to the heart and a subsequent heart attack. A major underlying cause of atherosclerosis is the buildup of lipid-rich plaques within the coronary arteries. These plaques are problematic as they cause a narrowing of the artery in which they accumulate. Additionally they may rupture, leading to thrombus formation and total occlusion of the impacted artery. Recent clinical trials focusing on both interventional and pharmacological management of CHD highlight strategies that have the potential to improve patient outcomes.

If undertaken early enough, preventive strategies, including lifestyle/diet management, control of hypertension, and cholesterol management, can reduce the onset or progression of CHD. Statin therapy has been shown in clinical trials to be effective in managing cholesterol levels and plaque progression, and trials are underway to investigate whether statins can promote plaque regression as well. In high-risk CHD patients, or those presenting with acute symptoms, interventional strategies are often utilized together with pharmacotherapeutic strategies. Interventional strategies include balloon angioplasty and/or the insertion of a stent into an occluded artery in an effort to restore normal blood flow within the vessel. Pharmacotherapeutic strategies, including anticoagulant and antiplatelet therapies, aim to prevent or reduce thrombus formation. They are often used in conjunction with interventional strategies but may be used alone, depending on the level of patient risk. Recent clinical trials highlight the need for risk stratification of patients and suggest that in lower-risk patients medical/lifestyle management alone may be as effective as interventional therapy in preventing disease progression and death. However, these trials also support the use of interventional therapies in higher-risk patients.

To help physicians gain a clearer understanding of how recent advances can improve the management of their patients with CVD, a multidisciplinary group of thought leaders with proven experience in treating CVD and related disorders has formed the IMPACT (Innovative Medical Practices Advancing Cardiovascular Therapy) Council. The Council's goal is to deliver a consistent message to other physicians regarding the importance of aggressive management of CVD and the need to understand the roles that the RAAS and SNS as well as cholesterol and platelet dynamics play in causing cardiovascular events. IMPACT messages delivered via weekly e-newsletters are invaluable resources, allowing cardiovascular specialists and primary care physicians to stay current in the field of cardiovascular medicine. In addition to fulfillment of CME requirements, receipt of the IMPACT newsletter serves as a way for physicians to remain informed of current trends and advances relevant to their practice and delivery of optimal patient care. The newsletter enables physicians to comply with what the AMA states is "the physician's ethical obligation to maintain his or her medical expertise." ²

Click here to view the current members of the IMPACT Council.

1. Rosamond W, Flegal K, Friday G, et al. Heart disease and stroke statistics--2007 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2007;115:e69-171.

2. Association. AM. Code of Medical Ethics. E-9.011 Continuing Medical Education. Available here.
Accessed April 23, 2007.

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