doi: 10.1161/01.CIR.0000020190.45892.75
(Circulation. 2002;106:388.)
© 2002 American Heart Association, Inc.
AHA Scientific Statement |
AHA Guidelines for Primary Prevention of Cardiovascular Disease and Stroke: 2002 Update
Consensus Panel Guide to Comprehensive Risk Reduction for Adult Patients Without Coronary or Other Atherosclerotic Vascular Diseases
Key Words: AHA Scientific Statements • prevention • risk factors • cardiovascular disease • stroke
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Introduction |
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The initial Guide to the Primary Prevention of Cardiovascular Diseases was published in 1997 as an aid to healthcare professionals and their patients without established coronary artery disease or other atherosclerotic diseases.1 It was intended to complement the American Heart Association (AHA)/American College of Cardiology (ACC) Guidelines for Preventing Heart Attack and Death in Patients with Atherosclerotic Cardiovascular Disease (updated2) and to provide the healthcare professional with a comprehensive approach to patients across a wide spectrum of risk. The imperative to prevent the first episode of coronary disease or stroke or the development of aortic aneurysm and peripheral arterial disease remains as strong as ever because of the still-high rate of first events that are fatal or disabling or require expensive intensive medical care. The evidence that most cardiovascular disease is preventable continues to grow. Results of long-term prospective studies consistently identify persons with low levels of risk factors as having lifelong low levels of heart disease and stroke.3,4 Moreover, these low levels of risk factors are related to healthy lifestyles. Data from the Nurses Health Study,5 for example, suggest that in women, maintaining a desirable body weight, eating a healthy diet, exercising regularly, not smoking, and consuming a moderate amount of alcohol could account for an 84% reduction in risk, yet only 3% of the women studied were in that category. Clearly, the majority of the causes of cardiovascular disease are known and modifiable.
This 2002 update of the Guide acknowledges a number of advances in the field of primary prevention since 1997. Research continues to refine the recommendations on detection and management of established risk factors, including evidence against the safety and efficacy of interventions once thought promising (eg, antioxidant vitamins).6 This, in turn, has stimulated a large number of additional guidelines for specific demographic groups (eg, women), on individual risk factors (eg, diabetes, smoking), and for the primary prevention of stroke. In all of these guidelines, there is an increasing emphasis on further stratifying patients by level of risk and matching the intensity of interventions to the hazard for cardiovascular disease events.7
Therefore, this 2002 update of the Primary Prevention Guide serves to integrate other guidelines and consensus statements developed since the initial Guide’s approval. This Guide might be viewed as the entry point to the more specific and detailed recommendations and the rationale behind them. The recommendations, as presented in the accompanying tables, are therefore consistent with the following recommendations: Agency for Healthcare Policy and Research Guidelines on Treating Tobacco Use and Dependence8; the Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI)9; the AHA Dietary Guidelines, Revision 200010; the AHA Statement on Alcohol and Heart Disease11; the Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults12; American Heart Association Scientific Statements and Advisories on Physical Activity13,14 and the American College of Sports Medicine Guidelines15; the Clinical Guidelines for the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults from the National Heart, Lung, and Blood Institute Expert Panel16 and an accompanying statement from the AHA Nutrition Committee17; the American Diabetes Association Standards of Medical Care for Patients with Diabetes18,19 and the AHA Statement on Diabetes and Cardiovascular Disease20; the AHA Guidelines on the Primary Prevention of Stroke21; AHA Guidelines for Prevention of Cardiovascular Disease in Women22; ACC/AHA/European Society of Cardiology (ESC) Guidelines for the Management of Patients With Atrial Fibrillation23; the AHA Scientific Statement on Hormone Replacement Therapy and Cardiovascular Disease24; and the US Preventive Services Task Force evidence for use of aspirin in primary prevention.25 The aspirin guidelines recommended here agree with the Task Force Report in the use of aspirin in persons at high coronary and stroke risk but use a 
10% risk per 10 years rather than >6% risk over 10 years. This improves the likelihood of a positive balance of coronary risk reduction over bleeding and hemorrhagic stroke caused by aspirin.26,27
Although this Guide largely applies to adults, it does identify high-risk patients for whom screening and intervention in first-degree relatives (including children) would be an important aspect of primary prevention. However, this Guide will not provide specific recommendations for the reduction of cardiovascular risk in children and adolescents. This important issue will be the subject of a separate guide. However, a family-centered approach to primary prevention should be emphasized, inasmuch as it recognizes both the genetic and behavioral causes of the well-established familial aggregation of heart disease and stroke.
This Guide is intended to assist primary care providers in their assessment, management, and follow-up of patients who may be at risk for but who have not yet manifested cardiovascular disease. The continuing message is that adoption of healthy life habits remains the cornerstone of primary prevention, including the avoidance of tobacco (including secondhand smoke), healthy dietary patterns, weight control, and regular, appropriate exercise. An important role of healthcare providers is to support and reinforce these public health recommendations for all patients.
Table 1 is presented to guide the identification and assessment of modifiable risk. The assessment of absolute cardiac risk is increasingly advocated by international organizations and by individual risk factor guidelines in the United States.12,25,28 The Framingham database has been widely used, though we acknowledge that the multiple risk score may not apply equally to all sex, race, and ethnic groups.29,30 The use of more sophisticated technologies than a risk factor inventory and global risk score has been addressed,31 and we conclude that most screening tests for occult atherosclerosis remain in the research arena, with the exception of the ankle-brachial blood pressure index. Similarly, those recommended interventions involving "nutriceutical" and pharmaceutical interventions in Table 2 have support from randomized clinical trials establishing their efficacy and safety. More controversial interventions, such as very low-fat diets,32 dietary supplements,6,33 and potentially cardioprotective drugs other than aspirin require additional investigation in well-designed clinical trials in persons without established cardiovascular disease.
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The gap between which evidence-based interventions are recommended and what is actualized is large.34,35 Guidelines, even when based on the best available evidence from randomized, controlled trials, cannot be successfully implemented without acceptance by the entire healthcare team, including physicians, nurses, nutritionists, and other healthcare professionals. A physician-patient partnership must be forged, on the physician’s part by assessing and communicating risk and by codeveloping with the patient a plan of preventive action. New tools for providers are available to foster this partnership, such as the AHA’s Get With the Guidelines.36 Information for the public on cardiovascular and stroke risk factors is available on the AHA web site.37
The challenge for healthcare professionals is to engage greater numbers of patients, at an earlier stage of their disease, in comprehensive cardiovascular risk reduction with the use of interventions that are designed to circumvent or alleviate barriers to participation and adherence, so that many more individuals may realize the benefits that primary prevention can provide. The healthcare professional should create an environment supportive of risk factor change, including long-term reinforcement of adherence to lifestyle and drug interventions. Practice-based systems for risk factor monitoring, reminders, and support services need to be established, reimbursed, and otherwise supported by managed care organizations and third-party payers. Primary prevention, by its very nature, requires a lifetime of interactions that virtually define successful provider-patient relationships.
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Footnotes |
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The American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest.
This statement was approved by the American Heart Association Science Advisory and Coordinating Committee on February 21, 2002. A single reprint is available by calling 800-242-8721 (US only) or writing the American Heart Association, Public Information, 7272 Greenville Ave, Dallas, TX 75231-4596. Ask for reprint No. 71-0226. To purchase additional reprints: up to 999 copies, call 800-611-6083 (US only) or fax 413-665-2671; 1000 or more copies, call 410-528-4426, fax 410-528-4264, or e-mail kbradle@lww.com. To make photocopies for personal or educational use, call the Copyright Clearance Center, 978-750-8400.
*From the Population Science Committee of the American Heart Association. 
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TopIntroductionReferences |
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2. Smith SC Jr, Blair SN, Bonow RO, et al. AHA/ACC Scientific Statement: AHA/ACC guidelines for preventing heart attack and death in patients with atherosclerotic cardiovascular disease: 2001 update: a statement for healthcare professionals from the American Heart Association and the American College of Cardiology. Circulation. 2001; 104: 1577–1579.
3. Rosengren A, Dotevall A, Eriksson H, et al. Optimal risk factors in the population: prognosis, prevalence, and secular trends; data from Goteborg population studies. Eur Heart J. 2001; 22: 136–144.
4. Stamler J, Stamler R, Neaton JD, et al. Low risk factor profile and long-term cardiovascular and noncardiovascular mortality and life expectancy: findings for 5 large cohorts of young adult and middle-aged men and women. JAMA. 1999; 282: 2012–2018.
5. Stampfer MJ, Hu FB, Manson JE, et al. Primary prevention of coronary heart disease in women through diet and lifestyle. N Engl J Med. 2000; 343: 16–22.
6. Yusuf S, Dagenais G, Pogue J, et al. Vitamin E supplementation and cardiovascular events in high-risk patients. The Heart Outcomes Prevention Evaluation Study Investigators. N Engl J Med. 2000; 342: 154–160.
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8. Agency for Healthcare Policy and Research. Treating Tobacco Use and Dependence: US Department of Health and Human Services Public Health Services Report. Washington, DC: US Government Printing Office; 2000.
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15. American College of Sports Medicine. ACSM’s Guidelines for Exercise Testing and Prescription. 6th ed. Baltimore, Md: Lippincott Williams and Wilkins; 2000.
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20. Grundy SM, Benjamin IJ, Burke GL, et al. Diabetes and cardiovascular disease: a statement for healthcare professionals from the American Heart Association. Circulation. 1999; 100: 1134–1146.
21. Goldstein LB, Adams R, Becker K, et al. Primary prevention of ischemic stroke: a statement for healthcare professionals from the Stroke council of the American Heart Association. Circulation. 2001; 103: 163–182.
22. Mosca L, Grundy SM, Judelson D, et al. Guide to preventive cardiology for women: AHA/ACC scientific statement consensus panel statement. Circulation. 1999; 99: 2480–2484.
23. Fuster V, Ryden LF, Asinger RW, et al. ACC/AHA/ESC guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines and Policy Conferences (Committee to Develop Guidelines for the Management of Patients with Atrial Fibrillation) developed in collaboration with the North American Society of Pacing and Electrophysiology. Eur Heart J. 2001; 22: 1852-1923.
24. Mosca L, Collins P, Herrington DM, et al. Hormone replacement therapy and cardiovascular disease: a statement for healthcare professionals from the American Heart Association. Circulation. 2001; 104: 499–503.
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26. Collaborative meta-analysis of randomized trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. Antithrombotic Trialists Collaboration. BMJ. 2002; 324: 71–86.
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28. Third report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) full report: manuscript version. National Heart, Lung, and Blood Institute web site. Available at: http://www.nhlbi.nih.gov/guidelines/cholesterol/atp3_rpt.htm. Pages III-3–III-8. Accessed June 1, 2002.
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31. Smith SC Jr, Greenland P, Grundy SM. AHA Conference Proceedings: Prevention Conference V: beyond secondary prevention: identifying the high-risk patient for primary prevention: executive summary. American Heart Association. Circulation. 2000; 101: 111–116.
32. Lichtenstein AH, Van Horn L. Very low fat diets. Circulation. 1998; 98: 935–939.
33. Tribble DL. AHA science advisory: antioxidant consumption and risk of coronary heart disease: emphasis on vitamin C, vitamin E, and beta-carotene: a statement for healthcare professionals from the American Heart Association. Circulation. 1999; 99: 591–595.
34. Pearson TA, McBride PE, Houston-Miller N, et al. 27th Bethesda Conference: matching the intensity of risk factor management with the hazard for coronary disease events. Task Force 8. Organization of preventive cardiology service. J Am Coll Cardiol. 1996; 27: 1039–1047.[CrossRef][Medline] [Order article via Infotrieve]
35. Burke LE, Ockene IS, eds. Compliance in Healthcare and Research. Armonk, NY: Futura Publishing Co; 2001.
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J. L. Anderson, C. D. Adams, E. M. Antman, C. R. Bridges, R. M. Califf, D. E. Casey Jr, W. E. Chavey II, F. M. Fesmire, J. S. Hochman, T. N. Levin, et al. ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction) Developed in Collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons Endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine J. Am. Coll. Cardiol., August 14, 2007; 50(7): e1 - e157. [Full Text] [PDF]
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A. Ois, E. Cuadrado-Godia, J. Jimenez-Conde, M. Gomis, A. Rodriguez-Campello, J. E. Martinez-Rodriguez, E. Munteis, and J. Roquer Early Arterial Study in the Prediction of Mortality After Acute Ischemic Stroke Stroke, July 1, 2007; 38(7): 2085 - 2089. [Abstract] [Full Text] [PDF]
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C. A. Garza, V. M. Montori, and F. Lopez-Jimenez Role of Lipoprotein-Associated Phospholipase A2 in Predicting Risk of Cardiovascular Disease-Reply-I Mayo Clin. Proc., July 1, 2007; 82(7): 888 - 888. [Full Text] [PDF]
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W.-J. Jiang, X.-T. Xu, M. Jin, B. Du, K.-H. Dong, and J.-P. Dai Apollo Stent for Symptomatic Atherosclerotic Intracranial Stenosis: Study Results AJNR Am. J. Neuroradiol., May 1, 2007; 28(5): 830 - 834. [Abstract] [Full Text] [PDF]
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M. S. Lauer Primary Prevention of Atherosclerotic Cardiovascular Disease: The High Public Burden of Low Individual Risk JAMA, March 28, 2007; 297(12): 1376 - 1378. [Full Text] [PDF]
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M. Madjid, R. V. Luepker, K. J. Greenlund, K. A. Taubert, M. J. Roy, and R. M. Robertson Task Force IV: Cardiovascular Effects of Emerging Infectious Diseases and Biological Terrorism Threats: Basic, Clinical, and Population Science Research and Training Needs J. Am. Coll. Cardiol., March 27, 2007; 49(12): 1407 - 1412. [Full Text] [PDF]
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D. C. Goff Jr, L. Brass, L. T. Braun, J. B. Croft, J. D. Flesch, F. G.R. Fowkes, Y. Hong, V. Howard, S. Huston, S. F. Jencks, et al. Essential Features of a Surveillance System to Support the Prevention and Management of Heart Disease and Stroke: A Scientific Statement From the American Heart Association Councils on Epidemiology and Prevention, Stroke, and Cardiovascular Nursing and the Interdisciplinary Working Groups on Quality of Care and Outcomes Research and Atherosclerotic Peripheral Vascular Disease Circulation, January 2, 2007; 115(1): 127 - 155. [Full Text] [PDF]
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C. Napoli, L. O. Lerman, F. de Nigris, M. Gossl, M. L. Balestrieri, and A. Lerman Rethinking Primary Prevention of Atherosclerosis-Related Diseases Circulation, December 5, 2006; 114(23): 2517 - 2527. [Full Text] [PDF]
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M. J. Budoff, S. Achenbach, R. S. Blumenthal, J. J. Carr, J. G. Goldin, P. Greenland, A. D. Guerci, J. A.C. Lima, D. J. Rader, G. D. Rubin, et al. Assessment of Coronary Artery Disease by Cardiac Computed Tomography: A Scientific Statement From the American Heart Association Committee on Cardiovascular Imaging and Intervention, Council on Cardiovascular Radiology and Intervention, and Committee on Cardiac Imaging, Council on Clinical Cardiology Circulation, October 17, 2006; 114(16): 1761 - 1791. [Full Text] [PDF]
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J. J. Bax, R. O. Bonow, D. Tschope, S. E. Inzucchi, E. Barrett, and on behalf of the Global Dialogue Group for the Eva The Potential of Myocardial Perfusion Scintigraphy for Risk Stratification of Asymptomatic Patients With Type 2 Diabetes J. Am. Coll. Cardiol., August 15, 2006; 48(4): 754 - 760. [Abstract] [Full Text] [PDF]
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D. Cox, A. O. Maree, M. Dooley, R. Conroy, M. F. Byrne, and D. J. Fitzgerald Effect of Enteric Coating on Antiplatelet Activity of Low-Dose Aspirin in Healthy Volunteers Stroke, August 1, 2006; 37(8): 2153 - 2158. [Abstract] [Full Text] [PDF]
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L. B. Goldstein, R. Adams, M. J. Alberts, L. J. Appel, L. M. Brass, C. D. Bushnell, A. Culebras, T. J. DeGraba, P. B. Gorelick, J. R. Guyton, et al. Primary Prevention of Ischemic Stroke: A Guideline From the American Heart Association/American Stroke Association Stroke Council: Cosponsored by the Atherosclerotic Peripheral Vascular Disease Interdisciplinary Working Group; Cardiovascular Nursing Council; Clinical Cardiology Council; Nutrition, Physical Activity, and Metabolism Council; and the Quality of Care and Outcomes Research Interdisciplinary Working Group: The American Academy of Neurology affirms the value of this guideline. Circulation, June 20, 2006; 113(24): e873 - e923. [Abstract] [Full Text] [PDF]
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L. B. Goldstein, R. Adams, M. J. Alberts, L. J. Appel, L. M. Brass, C. D. Bushnell, A. Culebras, T. J. DeGraba, P. B. Gorelick, J. R. Guyton, et al. Primary Prevention of Ischemic Stroke: A Guideline From the American Heart Association/American Stroke Association Stroke Council: Cosponsored by the Atherosclerotic Peripheral Vascular Disease Interdisciplinary Working Group; Cardiovascular Nursing Council; Clinical Cardiology Council; Nutrition, Physical Activity, and Metabolism Council; and the Quality of Care and Outcomes Research Interdisciplinary Working Group: The American Academy of Neurology affirms the value of this guideline. Stroke, June 1, 2006; 37(6): 1583 - 1633. [Abstract] [Full Text] [PDF]
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R. S. Vasan Biomarkers of Cardiovascular Disease: Molecular Basis and Practical Considerations Circulation, May 16, 2006; 113(19): 2335 - 2362. [Full Text] [PDF]
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 D. I. Feig, M. Mazzali, D.-H. Kang, T. Nakagawa, K. Price, J. Kannelis, and R. J. Johnson Serum Uric Acid: A Risk Factor and a Target for Treatment? J. Am. Soc. Nephrol., April 1, 2006; 17(4_suppl_2): S69 - S73. [Abstract] [Full Text] [PDF]
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S. M. Grundy Metabolic Syndrome: Connecting and Reconciling Cardiovascular and Diabetes Worlds J. Am. Coll. Cardiol., March 21, 2006; 47(6): 1093 - 1100. [Abstract] [Full Text] [PDF]
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R. L. Sacco, R. Adams, G. Albers, M. J. Alberts, O. Benavente, K. Furie, L. B. Goldstein, P. Gorelick, J. Halperin, R. Harbaugh, et al. Guidelines for Prevention of Stroke in Patients With Ischemic Stroke or Transient Ischemic Attack: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association Council on Stroke: Co-Sponsored by the Council on Cardiovascular Radiology and Intervention: The American Academy of Neurology affirms the value of this guideline. Circulation, March 14, 2006; 113(10): e409 - e449. [Abstract] [Full Text] [PDF]
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M. Pignone, S. Earnshaw, J. A. Tice, and M. J. Pletcher Aspirin, statins, or both drugs for the primary prevention of coronary heart disease events in men: a cost-utility analysis. Ann Intern Med, March 7, 2006; 144(5): 326 - 336. [Abstract] [Full Text] [PDF]
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H. F. McGruder, J. B. Croft, and Z.-J. Zheng Characteristics of an "Ill-Defined" Diagnosis for Stroke: Opportunities for Improvement Stroke, March 1, 2006; 37(3): 781 - 789. [Abstract] [Full Text] [PDF]
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P. Kohli and P. Greenland Role of the Metabolic Syndrome in Risk Assessment for Coronary Heart Disease JAMA, February 15, 2006; 295(7): 819 - 821. [Full Text] [PDF]
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G. L. Gierach, B. D. Johnson, C. N. Bairey Merz, S. F. Kelsey, V. Bittner, M. B. Olson, L. J. Shaw, S. Mankad, C. J. Pepine, S. E. Reis, et al. Hypertension, Menopause, and Coronary Artery Disease Risk in the Women's Ischemia Syndrome Evaluation (WISE) Study J. Am. Coll. Cardiol., February 7, 2006; 47(3_Suppl_S): S50 - S58. [Abstract] [Full Text] [PDF]
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R. L. Sacco, R. Adams, G. Albers, M. J. Alberts, O. Benavente, K. Furie, L. B. Goldstein, P. Gorelick, J. Halperin, R. Harbaugh, et al. Guidelines for Prevention of Stroke in Patients With Ischemic Stroke or Transient Ischemic Attack: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association Council on Stroke: Co-Sponsored by the Council on Cardiovascular Radiology and Intervention: The American Academy of Neurology affirms the value of this guideline. Stroke, February 1, 2006; 37(2): 577 - 617. [Abstract] [Full Text] [PDF]
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J. S. Berger, M. C. Roncaglioni, F. Avanzini, I. Pangrazzi, G. Tognoni, and D. L. Brown Aspirin for the Primary Prevention of Cardiovascular Events in Women and Men: A Sex-Specific Meta-analysis of Randomized Controlled Trials JAMA, January 18, 2006; 295(3): 306 - 313. [Abstract] [Full Text] [PDF]
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L. L. Yan, M. L. Daviglus, K. Liu, J. Stamler, R. Wang, A. Pirzada, D. B. Garside, A. R. Dyer, L. Van Horn, Y. Liao, et al. Midlife Body Mass Index and Hospitalization and Mortality in Older Age JAMA, January 11, 2006; 295(2): 190 - 198. [Abstract] [Full Text] [PDF]
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M. E. Clouse, J. Chen, H. M. Krumholz, M. E. Clouse, J. Chen, and H. M. Krumholz Noninvasive Screening for Coronary Artery Disease With Computed Tomography Is Useful Circulation, January 3, 2006; 113(1): 125 - 146. [Full Text] [PDF]
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American Diabetes Association Standards of Medical Care in Diabetes-2006 Diabetes Care, January 1, 2006; 29(suppl_1): S4 - S42. [Full Text] [PDF]
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S. M. Grundy, J. I. Cleeman, S. R. Daniels, K. A. Donato, R. H. Eckel, B. A. Franklin, D. J. Gordon, R. M. Krauss, P. J. Savage, S. C. Smith Jr, et al. Diagnosis and Management of the Metabolic Syndrome: An American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement Circulation, October 25, 2005; 112(17): 2735 - 2752. [Full Text] [PDF]
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D. E. Laaksonen, L. Niskanen, K. Nyyssonen, K. Punnonen, T.-P. Tuomainen, and J. T. Salonen C-reactive protein in the prediction of cardiovascular and overall mortality in middle-aged men: a population-based cohort study Eur. Heart J., September 1, 2005; 26(17): 1783 - 1789. [Abstract] [Full Text] [PDF]
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J. J. Saseen ASHP Therapeutic Position Statement on the Daily Use of Aspirin for Preventing Cardiovascular Events Am. J. Health Syst. Pharm., July 1, 2005; 62(13): 1398 - 1405. [Full Text] [PDF]
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H. Koga, S. Sugiyama, K. Kugiyama, K. Watanabe, H. Fukushima, T. Tanaka, T. Sakamoto, M. Yoshimura, H. Jinnouchi, and H. Ogawa Elevated Levels of VE-Cadherin-Positive Endothelial Microparticles in Patients With Type 2 Diabetes Mellitus and Coronary Artery Disease J. Am. Coll. Cardiol., May 17, 2005; 45(10): 1622 - 1630. [Abstract] [Full Text] [PDF]
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C. Heiss, S. Keymel, U. Niesler, J. Ziemann, M. Kelm, and C. Kalka Impaired Progenitor Cell Activity in Age-Related Endothelial Dysfunction J. Am. Coll. Cardiol., May 3, 2005; 45(9): 1441 - 1448. [Abstract] [Full Text] [PDF]
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Task Force Members, L. H. Schwamm, A. Pancioli, J. E. Acker III, L. B. Goldstein, R. D. Zorowitz, T. J. Shephard, P. Moyer, M. Gorman, S. C. Johnston, et al. Recommendations for the Establishment of Stroke Systems of Care: Recommendations From the American Stroke Association's Task Force on the Development of Stroke Systems Stroke, March 1, 2005; 36(3): 690 - 703. [Full Text] [PDF]
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L. H. Schwamm, A. Pancioli, J. E. Acker III, L. B. Goldstein, R. D. Zorowitz, T. J. Shephard, P. Moyer, M. Gorman, S. C. Johnston, P. W. Duncan, et al. Recommendations for the Establishment of Stroke Systems of Care: Recommendations From the American Stroke Association's Task Force on the Development of Stroke Systems Circulation, March 1, 2005; 111(8): 1078 - 1091. [Full Text] [PDF]
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L. Mosca, A. H. Linfante, E. J. Benjamin, K. Berra, S. N. Hayes, B. W. Walsh, R. P. Fabunmi, J. Kwan, T. Mills, and S. L. Simpson National Study of Physician Awareness and Adherence to Cardiovascular Disease Prevention Guidelines Circulation, February 1, 2005; 111(4): 499 - 510. [Abstract] [Full Text] [PDF]
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R. Bugiardini and C. N. Bairey Merz Angina With "Normal" Coronary Arteries: A Changing Philosophy JAMA, January 26, 2005; 293(4): 477 - 484. [Abstract] [Full Text] [PDF]
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R. J. Johnson, D. I. Feig, J. Herrera-Acosta, and D.-H. Kang Resurrection of Uric Acid as a Causal Risk Factor in Essential Hypertension Hypertension, January 1, 2005; 45(1): 18 - 20. [Full Text] [PDF]
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