CCDP Programs

1. Hypertension Management Program
2. Cholesterol Management Program
3. Metabolic Syndrome Management Program
4. Comprehensive Atherosclerosis Management Program
5. Heart Check Comprehensive Assessment Program

Hypertension Management Program

Hypertension afflicts nearly 50 million Americans.  Despite recent progress in the rates of detection and treatment, only 34% of hypertensive patients are achieving their goal blood pressure.  At the Center for Cardiovascular Disease Prevention, we are happy to provide assessments for patients with difficult to control hypertension.  Work-up begins with a complete history and physical exam along with a careful medication and lifestyle review.  If necessary, 24-hour ambulatory blood pressure monitoring can be done to confirm blood pressure status outside the office.  Additional blood and urine tests along with an electrocardiogram complete the evaluation for many.  For those with unusual presentations, further testing with heart ultrasound (echocardiogram) or special imaging techniques can be arranged.  Dr. Carmouche has been certified as a Specialist in Clinical Hypertension by the American Society of Hypertension.

 Patients who might benefit from hypertension specialty care:

• Failure to reach target blood pressure despite 3 drugs, at least one of which should be a diuretic
• Suspected “white coat” hypertension – normal blood pressure at home, elevated at the doctor’s office
• Intolerant of many blood pressure medications
• Diabetes
• Chronic kidney disease
• Pregnant patients
• High blood pressure presenting at < 30 years of age, or sudden, unexplained worsening of previously well-controlled hypertension

Cholesterol Management Program

Abnormalities in blood cholesterol and/or triglyceride levels contribute to much of the heart disease in the United States.  According to the recent, landmark INTERHEART study, abnormal ratios of “bad” cholesterol to “good” cholesterol contributed to nearly half of the first attacks in younger patients around the world.  Intensive control of cholesterol has been shown in many different trials to reduce the risk of heart attack and stroke in patients with and without previously diagnosed vascular disease. 

Unfortunately, most patients, even those at highest risk, fail to achieve target cholesterol levels.  The reasons are complex but likely include poor adherence to lifestyle recommendations (or poor lifestyle recommendations!), lack of regular medication taking, inadequate dosages of commonly prescribed drugs, failure to use appropriate combinations of drugs, and side-effects from cholesterol drugs. 

While many patients can have their cholesterol controlled with appropriate diet and moderate doses of commonly used medications, some patients will require high dosages of medications or combinations of multiple medications.  As the treatment becomes increasingly complex, the possibility of side-effects, drug interactions, and even toxicity becomes more frequent.  Dr. Carmouche is a Diplomate of the American Board of Clinical Lipidology.  This is the only certifying body which specifically attests to a thorough understanding of the clinical management of complex cholesterol disorders. 

Patients referred to the Center for Cardiovascular Disease Prevention for cholesterol abnormalities will complete a heath and nutritional survey prior to their visit.  Following a complete physical examination and review of prior labs and treatment history, most patients will undergo a battery of laboratory (blood) tests to exclude secondary causes of abnormal cholesterol (thyroid, kidney, and liver disorders) as well as “advanced cholesterol testing.”  Advanced cholesterol testing provides additional information about the nature of the cholesterol disorder and helps in devising a tailored treatment plan. 

Newer biomarkers (high-sensitivity CRP, lipoprotein (a), homocysteine, lipoprotein-associated phospholipase A2) may be ordered to further assess risk in patients deemed to be at intermediate risk for cardiovascular disease.  A growing number of imaging tests seek to detect “subclinical” atherosclerosis (early blockages which are not symptomatic,) and our staff can determine if these tests would be helpful in determining the intensity of cholesterol treatment.

Patients who might benefit from evaluation at the Center include:

• Diabetics with low HDL (“good”) cholesterol and high triglycerides
• Any patient with total cholesterol > 220 AND triglycerides > 200
• Markedly elevated LDL (“bad”) cholesterol > 200
• Isolated low HDL cholesterol (normal total cholesterol and triglycerides)
• Strong family history of early heart disease (males < 55 years old, females < 65 years old)
• Need for combination therapy (2 or more cholesterol drugs)
• Patients with prior heart attack, stroke, or revascularization procedure (bypass or angioplasty) who are having evidence of disease progression despite treatment
• Intolerant of cholesterol drugs, especially “statins” like Lipitor, Crestor, Zocor, Pravachol, Lescol, Mevacor, and Vytorin

Metabolic Syndrome Management Program

The metabolic syndrome has been called the “Next Great American Epidemic,” because of the growing number of patients in the United States with the obesity-related disorder.  Patients with metabolic syndrome have multiple clinical conditions which together predispose to premature heart disease and diabetes.  The problem has both genetic and environmental causes.  Afflicted patients tend to accumulate extra fat in the abdomen which leads to problems with insulin resistance, high blood pressure, cholesterol and triglyceride abnormalities, and clotting abnormalities.  Metabolic syndrome is associated with a higher risk for coronary artey disease, stroke, and cardiovascular deaths.  This risk is approximately 2-3 times that of an individual without metabolic syndrome.  The risk for developing diabetes is even greater, approximately 20-fold higher!

Patients with metabolic syndrome require comprehensive lifestyle education as appropriate changes in diet and exercise can largely control this disorder.  As an example, patients with the metabolic syndrome reduced their rate of progression to diabetes by 58% in the Diabetes Prevention Project by adopting a better diet and engaging in regular walking.  Patients with metabolic syndrome referred to the Center for Cardiovascular Disease Prevention will receive a thorough explanation of the disorder, individualized dietary counseling, and exercise counseling along with a comprehensive physical exam and appropriate laboratory testing.  If medications are required to further control individual risk factors, we will insure that medications are chosen that do not aggravate the underlying condition.  (For example, many blood pressure medications actually worsen insulin resistance.)

Comprehensive Atherosclerosis Management Program

Most patients with vascular disease (prior heart surgery, angioplasty, stroke) have multiple, modifiable risk factors.  Patients referred to this program will receive comprehensive risk factor assessment and treatment.  It has been shown that the incidence of cardiovascular death and cardiovascular events might be reduced by 75-80% if appropriate steps are taken to manage high risk patients.

Patients seen in this program will be educated about their disease process and undergo therapy for cholesterol disorders, hypertension, and insulin resistance or diabetes, if appropriate.  Appropriate anti-platelet (blood-thinning) treatments will be recommended as well.  A nutritional and lifestyle assessment will be completed and counseling performed where necessary.  Patients in this program will be followed regularly to assess compliance with therapy and to monitor for disease progression.

Patients with known vascular disease are at the highest risk.  Our goal in treating such patients is to effectively halt the progression of their disease.  Studies have shown that this is possible in many, if not most patients

Heart Check Comprehensive Assessment Program

Heart Check is a comprehensive cardiovascular wellness and risk assessment program. It is designed for both the patient with vascular disease as well as those interested in their current risk and likelihood of future heart attack or stroke. Patients do not need a referral from a physician to access this program. We provide an efficient, very thorough and comprehensive vascular risk assessment, including assessment of lifestyle factors, coexisting medical conditions, family history, state-of-the-art laboratory testing of lipoproteins and newer "biomarkers," as well as vascular imaging with CT scan and/or carotid intimal media thickness tetsing.

We believe that most heart attacks are preventable. In many respects, heart attacks and strokes are a result of a health system failure. Our current system provides little time for in-depth, individualized, physician-patient counseling. In some instances, routine risk assessment fails to reveal the true nature of a patient's vascular risk, and in these cases a thorough understanding of the role of newer tests is critical. Because we focus exclusively on preventive cardiology, we feel we are uniquely qualified to perform this function.

Patients selecting the Heart Check option will be sent a comprehensive health, dietary, and exercise questionairre to be completed in advance of their visit. Appropriate lab tests will be drawn, and imaging studies performed when necessary. On the day of the visit, patients will spend one hour with the Medical Director of the Center for Cardiovascular Disease Prevention. During that visit, a report detailing risk assessment will be discussed in depth. The implications of each result and the composite risk score will be explained. Specific dietary and exercise plans will be developed and recommendations for drug therapy and follow-up will be outlined. Importantly, we will provide ample time for questions.

Patients will leave with a complete report and copies of all studies. This program requires cash payment at the time of service. The cost of the physician encounter is $350.00 which includes the report generation. Lab testing and any imaging studies incur added costs. These are available prior to entry into this program. We believe that the value of the information will make participation quite cost-effective. To arrange a Heart Check appointment or for questions, please contact us by phone or e-mail us by clicking the referral tab. We look forward to helping you achieve your long-term heath goals!

If you would like to register for this program please contact us today!