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Coronary Heart Disease Prevention
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Frank Yanowitz; ed. 488 pages. New York: Marcel Dekker; 1992. $69.75.
It is nearly impossible to evaluate or treat a patient with heart disease without at some point considering the significance and implications of past and present risk factors. Despite the obvious central importance of risk factors to the overall care of a patient, few health care professionals, save epidemiologists, seem to appreciate the rewards that may follow successful risk factor modification; fewer still acknowledge by deed the value of attention to risk factors in patients with cardiac maladies. To be sure, physician and patient awareness are both gradually increasing. However, the surprising absence of organized instruction by medical schools and hospital training programs on risk factors and techniques to address perturbations continues to result in the graduation of physicians who are capable of treating disease but not preventing it.
Physicians must learn that risk factor modification in patients with heart disease is not to be left to someone else; rather, the complete care of the patient necessitates intervention to prevent the onset or progression of disease. Yanowitz has edited a timely book on risk factors for coronary artery disease. This book clearly presents the scientific background for the conclusion that blood lipid levels, blood pressure, obesity, level of exercise, stress, and smoking are independent risk factors. The book also discusses practical guidelines for evaluating and dealing with these factors in a clinical population.
The clarity of presentation must be stressed. The obfuscation found in many treatises that describe risk factors and their clinical significance is absent. The book will be useful to the cardiologist and the family physician because neither has showed an overwhelming proclivity to realistically deal with risk factors in patients, with the exception of hypertension. The possibility exists that the preaching tone of many of the contributions and the chapters devoted to Dr. Yanowitz's personal ideology and philosophy may heighten suspicion and close the minds of some readers. However, the time has come to manage cardiac risk factors directly and help patients modify lifestyles when appropriate. This book helps to focus attention on these matters and it is hoped that it will convert bystanders into concerned interventionists.
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