Adult Cardiovascular Disease Prevention

Welcome to the Adult Cardiovascular Disease Prevention course. This course is designed to provide an understanding to the prevention of cardiovascular disease and is intended to provide the knowledge needed for clinically-prepared medical students, residents and practicing physicians.

The Adult Cardiovascular Disease Prevention course, like all NextGenU.org courses, is competency-based, using competencies from the ACCF/AHA/ACP 2009 Competence and Training Statement: A Curriculum on Prevention of Cardiovascular Disease. It uses learning resources from accredited, world-class organizations such as the American Heart Association, and National Institute of Health.

The  Adult Cardiovascular Disease Prevention course was created by Judith Thomas and was designed by the NextGenU.org team: Hugo Rojas, MD, MSc, DiplEd.

For publications on NextGenU.org’s courses’ efficacy, see the NextGenU.org’s publication page. Subscribe to our newsletter to be notified of future updates, new courses, and to be part of our community.

There are 18 modules to complete, which provide an introduction to:

• Module 1: Introduction to Preventive Cardiology 
• Module 2: Cardiovascular and Vascular Biology 
• Module 3: Clinical Epidemiology and Biostatistics 
• Module 4: Cardiovascular Pharmacology 
• Module 5: Genetics and Cardiovascular Disease in Individuals and Families 
• Module 6: Behavioural and Psychosocial Programs 
• Module 7: Advanced Risk Assessment (Renal, Inflammatory Disease) 
• Module 8: Subclinical Atherosclerosis Assessment 
• Module 9: Adherence and Disease Outcome Interdisciplinary Programs 
• Module 10: Nutrition Management 
• Module 11: Lipid Management (Management of Dyslipidemia) 
• Module 12: Thrombosis Management 
• Module 13: Hypertension Management
• Module 14: Smoking Cessation 
• Module 15: Obesity Management (Behavioral Programs)
• Module 16: Exercise Physiology, Physical Activity Management, and Cardiac Rehabilitation (Secondary Prevention)
• Module 17: Prediabetes, Metabolic Syndrome, Insulin Resistance, and Diabetes Management
• Module 18: Chronic Disease Management

Engaging with this course:

You may browse this course for free to learn for your personal enrichment; there are no requirements.

To obtain a certificate, a learner must first register for the course and then successfully complete:

• All the reading requirements,
• All quizzes and pass with a 70% with unlimited attempts,
• The final exam with a minimum of 70% and a maximum of 3 attempts, and
• The self and course evaluation forms.

To obtain credit:

• Complete all requirements listed above for the certificate, and
• Your learning institution or workplace should approve the partner-university-sponsored NextGenU.org course for educational credit, as they would for their learner taking a course anywhere. 

NextGenU.org is happy to provide your institution with:

• A link to and description of the course training, so they can see all its components, including the cosponsoring universities and other professional organization cosponsors; 
• Your grade on the final exam;
• Your work products, and any other required or optional shared materials that you produce and authorize to share with them;  
• Your evaluations -- course, and self-assessments;
• A copy of your certificate of completion, with the co-sponsoring universities and other organizations listed.

To obtain a degree, NextGenU.org co-sponsors degree programs with institutional partners. To obtain a full degree co-sponsored with NextGenU.org, registrants must be enrolled in a degree program as a student of a NextGenU.org institutional partner. If you think that your institution might be interested in offering a degree with NextGenU.org contact us.

We hope that you will find this a rewarding learning experience, and we count on your assessment and feedback to help us improve this training for future students.

Here are the next steps to take the course and earn a certificate.

• Complete the registration form.
• Take the pre-test.
• Begin the course with Module 1: Introduction to Preventive Cardiology. In each lesson, read the description, complete all required readings and any required activity, as well as take the corresponding quizzes.

*This course is sponsored in part by the Annenberg Physician Training Program: Abstinence-based Recovery from Addictive Disease. Click here to see curricular threading related to mental health disorders.

Competencies covered in this module:

• To understand preventive cardiology and a basic introduction to its importance.
• To learn how to approach a cardiovascular patient, how to take a proper history, and perform a cardiac examination.

Learning Objectives:

• Students should understand the importance of strategies aimed at the appropriate detection and modification of risk factors can slow progression of atherosclerosis, diabetes mellitus, and hypertension, and reduce the occurrence of clinical cardiovascular events in both primary and secondary prevention settings.

Click here to start this lesson

Learning Objectives:

• Students should have the understanding on how to approach a cardiovascular patient, how to take a proper history and how to perform a cardiac examination.
  

Click here to start this lesson

Competencies covered in this module:

• The process of atherosclerosis that begins in youth, initially as a fatty streak containing mainly lipid-rich macro-phages in the arterial intima, and the role of various blood lipoproteins in this process and the factors that promote the initiation and progression of the fatty streak to arterial plaque (including endothelial activation and dysfunction, smooth muscle cell migration and proliferation, collagen production, and arterial remodeling).
• Disorders of lipid metabolism and major atherogenic risk factors, and the pathophysiological significance of the biological composition of the arterial plaque and its fibrous cap.
  
• A substantial understanding of vulnerable plaque and the crucial role of inflammation, plaque fissuring, erosion, and rupture in the genesis of acute coronary syndromes, should be emphasized. An understanding of the concepts of plaque pathophysiology remodeling and progression should also be understood, as well as an appreciation of the systemic nature of atherosclerosis.
  
• Systemic (endocrine) and local (autocrine/paracrine) neurohormonal derangements that lead to an impaired vasoregulatory and fibrinolytic balance, including the biological, social, and environmental determinants of these derangements as well as the pharmacologic and therapeutic lifestyle changes established for their control.
  
• Mechanisms of atherosclerosis-specific targeted interventions with the use of combination medications that can be used to slow progression and reverse the process.
  
• Vascular and hemodynamic benefits of smoking cessation, increased physical activity, and a diet low in saturated fats and rich in fruits, vegetables, fiber, and whole grains, particularly promoted at an early age.

Learning Objectives:

• Students should have a solid understanding of the process of atherosclerosis that begins at youth, the role of various lipoproteins in this process, and the factors that promote the initiation and progression of the fatty streak to arterial plaque.
  

Click here to start this lesson

Learning Objectives:

• Students should understand the different lipid disorders and major atherogenic risk factors and the pathophysiological significance of the biological composition of the arterial plaque and its fibrous cap.
  

Click here to start this lesson

Learning Objectives:

• Students should have the knowledge of the crucial role of plaques in inflammation, plaque fissuring, erosion, and rupture in the genesis of acute coronary syndromes and a solid understanding of plaque pathophysiology in remodeling and progression.
  

Click here to start this lesson

Learning Objectives:

• Students should learn the systemic (endocrine) and local (autocrine/paracrine) neurohormonal derangements that lead to an impaired vasoregulatory and fibrinolytic balance, including the biological, social, and environmental determinants of these derangements.
  

Click here to start this lesson

Learning Objectives:

• Students should understand the mechanisms of atherosclerosis-specific targeted interventions with the use of combination medications that can be used to slow progression and reverse the process.

Click here to start this lesson

Learning Objectives:

• Students should understand the vascular and hemodynamic benefits of smoking cessation, increased physical activity, and a diet low in saturated fats and rich in fruits, vegetables, fiber, and whole grains, particularly promoted at an early age.
  

Click here to start this lesson

Competencies covered in this module:

• Terms used to describe the central tendency of population distributions (e.g., mean, median, and mode), and the terms used to describe the magnitude of dispersion around these measures (e.g., standard deviation, standard error, and percentiles). Familiarity with terms that describe the frequency and burden of CVD as well as the importance of age adjustment.
• Terms used to characterize screening and diagnostic tests, including sensitivity, specificity, accuracy, and predictive values (positive and negative).
• Experimental study designs (randomized, nonrandomized, and noninferiority clinical trials) and nonexperimental designs (cohort, case-control, nested case-control, cross-sectional studies), as well as the principle of hypothesis testing that underlies these studies, and the number needed to treat and the number needed to harm.
• Common analyses encountered in the medical literature, such as the t test, chi-square test, multiple regression, Kaplan-Meier survival analysis, and the Cox proportional hazards analysis is necessary, including the types of errors that can be committed when inferences are made about data in studies.
• Traditional risk factors and nontraditional risk factors, such as calculation of non–high-density lipoprotein cholesterol (non–HDL-C) in persons with triglyceride levels above 200 mg/dL.
• Inflammatory biomarkers, including high sensitivity C reactive protein, serum amyloid A, interleukin-6, lipoprotein associated phospholipase A2, monocyte chemoattractant protein-1, soluble CD40 ligand, myeloperoxidase and their possible utility in risk assessment.
• The concepts of relative and absolute risk; short-term, long-term, and lifetime risk; and the population burden of CVD attributable to specific risk factors, including the Framingham Risk Assessment score in clinical practice and knowledge of its limitations.
• Cost-benefit analyses of CVD interventions.

Learning Objectives:

• Students should understand the terms used to describe central tendency of population distributions (mean, median, mode) and magnitude of dispersion (standard deviation, standard error, percentiles).
  

Click here to start this lesson

Learning Objectives:

• Students should understand screening terms and diagnostic tests including sensitivity, specificity, accuracy, and predictive values.
  

Click here to start this lesson

Learning Objectives:

• Students should understand the different experimental and nonexperimental study designs and the principle of hypothesis testing.
  

Click here to start this lesson

Learning Objectives:

• Students should have a basic knowledge of common analysis in medical literature including the t-test, chi-square, regression, and types of errors committed.
  

Click here to start this lesson

Learning Objectives:

• Students should have a solid understanding of traditional and nontraditional risk factors in persons with high cholesterol. To understand inflammatory biomarkers and their utility in risk assessment.
  

Click here to start this lesson

Learning Objectives:

• Students should have a basic understanding of relative and absolute risk and a knowledge of the Framingham Risk Assessment in clinical practice.
  

Click here to start this lesson

Learning Objectives:

• Students should understand the benefits and disadvantages of CVD interventions.
  

Click here to start this lesson

Competencies covered in this module:

• Pharmacological approaches to lipids, hypertension, thrombosis, diabetes and insulin resistance, cigarette smoking cessation, and obesity The important role of statins and other lipid-lowering medications, antiplatelet therapies, renin-angiotensin-aldosterone system agents, and antihypertensive medications should be considered.
• Use of multiple drug combinations (coexistent conditions and risk factor clustering) and drug-drug interactions, including the ever-increasing complexity of pharmacological regimens and potential and realization of drug-drug interactions.
  
• Preventive cardiovascular strategies for comorbidities such as renal disease, autoimmune inflammatory disorders, diabetes mellitus, and cancer, which raise the risk for CVD due to the comorbidity itself as well as the treatment regimens used to treat these comorbidities.
  
• Pharmacologic dosing adjustment in consideration of issues of aging, gender, ethnicity, and comorbidities, for example, renal disease and liver disease and ethnicity. Aggressive preventive cardiovascular regimens are optimally tolerated when body weight– and renal function–adjusted, including the elderly, women, and smaller-sized men. Knowledge of ethnic groups that have higher rates of toxicity to certain medications is also important.
  
• Pharmacological interactions with over-the-counter supplements, nutriceuticals (soluble fiber, psyllium seed, stanol/sterol esters), and common dietary ingredients, such as grapefruit, which can interact with many common medications, including most statins, increasing blood levels of the medication when taken concurrently. A majority of patients are taking over-the-counter supplements that may interact with their medication, such as the antioxidant vitamins that adversely interact to reduce the antiatherosclerotic niacin benefit.
  
• Pharmacogenomics, including the prospective role of patient testing for genetic polymorphisms that raise/lower the likelihood of adverse pharmacological side effects, or lack of metabolism/efficacy with a particular class of medications.

Learning Objectives:

• Students should understand the pharmacological approaches to lipids, hypertension, thrombosis, diabetes, smoking cessation, and obesity. Students should know the important role of statins and other lipid-lowering medications, antiplatelet therapies, renin-angiotensin-aldosterone agents, and antihypertensive medications.
  

Click here to start this lesson

Learning Objectives:

• Students should learn the use of multiple drug combinations and drug-drug interactions and its complexity of regimens.

Click here to start this lesson

Learning Objectives:

• Students should learn the preventive cardiovascular strategies for comorbidities such as renal disease, autoimmune inflammatory disorders, diabetes mellitus, and cancer.
  

Click here to start this lesson

Learning Objectives:

• Students should understand the pharmacologic dosing adjustment in consideration of issues of aging, gender, ethnicity, and comorbidities.
  

Click here to start this lesson

Learning Objectives:

• Students should understand the pharmacological interactions with over-the-counter supplements, nutriceuticals (soluble fiber, psyllium seed, stanol/sterol esters), and common dietary ingredients, such as grapefruit, which can interact with many common medications, including most statins, increasing blood levels of the medication when taken concurrently.
  

Click here to start this lesson

Learning Objectives:

• Students should understand pharmacogenomics, including the prospective role of patient testing for genetic polymorphisms that raise/lower the likelihood of adverse pharmacological side effects, or lack of metabolism/efficacy with a particular class of medications.
  

Click here to start this lesson

Competencies covered in this module:

• Basic skills in eliciting a comprehensive family history during the patient encounter and familiarity with clinical tools and/or questionnaires for collecting genetic information.
• Differences between genotype and phenotype and the concepts of dominance, recessiveness, X-linked inheritance, genetic heterogeneity, and penetrance.
  
• Basic principles of clinical genetics including the types of family studies, linkage analyses, genetic association studies, and familiarity with recent advances in genome-wide association.
  
• Chromosomal deletions, duplications, and rearrangements as a cause of clinical syndromes associated with genetic disorders.
  
• Mendelian disorders and syndromes associated with congenital heart disease (e.g., DiGeorge, Noonan, and Williams syndromes) and those involving connective tissue (e.g., Marfan syndrome, Ehlers-Danlos syndrome).
  
• Genetic basis of specific cardiovascular disorders such as cardiomyopathies, arrhythmias, and lipoprotein disorders and their potential role in diagnostic evaluation and treatment.
  
• Teratogens including warfarin, hydantoin, retinoic acid, valproic acid, rubella, and alcohol.
  
• The indications for, as well as benefits, risks, and ethical implications of, referral for genetic testing and counseling, and the limitations of available testing kits.

Learning Objectives:

• Students should be able to understand the basics in comphrensive history taking during a patient encounter.
  

Click here to start this lesson

Learning Objectives:

• Students should be able to differentiate the concepts genotype, phenotype, dominance, recessiveness, X-linked inheritance, genetic, heterogeneity, and penetrance.
  

Click here to start this lesson

Learning Objectives:

• Students should be able to describe the basic principles of clinical genetics.
  

Click here to start this lesson

Learning Objectives:

• Students should be able to differentiate the clinical syndromes produced by different chromosomal deletions.
  

Click here to start this lesson

Learning Objectives:

• Students should be able to Identify Mendelian genetic disorders.
• Students should be able to Describe common congenital cardiovascular diseases.

Click here to start this lesson

Learning Objectives:

• Students should be able to recognize the genetic basis of cardiomyopathies.
  

Click here to start this lesson

Learning Objectives:

• Students should be able to identify common teratogens and the syndromes that they produce.
  

Click here to start this lesson

Learning Objectives:

• Students should be able to summarize the benefits, risks, and limitations of genetic testing.
• Students should be able to identify the characteristics and limitations of available testing kits.

Click here to start this lesson

Competencies covered in this module:

• Psychosocial factors in the development of CVD and CVD outcomes, particularly as barriers to treatment implementation.
• The diagnosis of anxiety and depression disorders, recognition of suicidality, and the appropriate use of referrals.
  
• Use of pharmacotherapies in the treatment of depression, including patient selection, side effects, monitoring for efficacy, and impact on risk factors.
  
• Recognition of safe treatments for anxiety and depression in patients with CVD.
  
• Recognition of when referral for psychiatric or psychologic care is needed and appropriate.
  
• Cardiac rehabilitation for the assessment and management of psychosocial conditions related to CVD.
  
• The role of healthcare systems and financing on psychosocial risks and outcomes for CVD, including the role of social workers and case managers in identifying and facilitating social services.

Learning Objectives:

• Students should be able to describe psychosocial factors in the development of Cardiovascular diseases and their outcomes.
  

Click here to start this lesson

Learning Objectives:

• Students should be able to recognize patients with anxiety, depression, and suicide-risk.
  

Click here to start this lesson

Learning Objectives:

• Students should be able to describe the pharmacologic approach of depression treatment, including patient selection, side effects, efficacy monitoring, and impact on risk factors.
  

Click here to start this lesson

Learning Objectives:

• Students should be able to recognize safe treatments for anxiety and depression in patients with CVD.
  

Click here to start this lesson

Learning Objectives:

• Students should be able to recognize when referral for psychiatric or psychologic care is needed and appropriate.
  

Click here to start this lesson

Learning Objectives:

• Students should be able to summarize the risks, benefits, and procedures for cardiac rehabilitation.

Click here to start this lesson

Learning Objectives:

• Students should be able to identify the role of work and the healthcare systems on psychosocial risks and outcomes for CVD.
  

Click here to start this lesson

Competencies covered in this module:

• Measurement of urinary albumin creatinine ratio in changing pharmacologic management.
• Inquiry regarding erectile difficulties on at least a yearly basis as a marker for early atherosclerotic vascular disease and generalized endothelial dysfunction.
  
• Measurement of systolic blood pressures in each brachial artery and one of the pedal arteries in each foot to calculate an ankle-brachial index, and the therapeutic implications for diagnosis of peripheral vascular disease, a CHD risk equivalent.
  
• Individuals with certain infectious diseases, chronic inflammatory conditions, and other collagen vascular diseases, as they are often at increased risk for atherosclerotic vascular disease and need to undergo comprehensive risk factor modification.
  
• Aggressive management of all risk factors, as appropriate, in patients with a history of chest wall irradiation, as they are prone to premature atherosclerotic disease.

Learning Objectives:

• Students should be able to describe disorders in urinary albumin ratio and its impact for cardiovascular disease.
  

Click here to start this lesson

Learning Objectives:

• Students should be able to analyze the relationship of erectile dysfunction and cardiovascular disease.
• Students should be able to recall the need of erectile difficulties yearly screening on cardiovascular patients.

Click here to start this lesson

Learning Objectives:

• Students should be able to analyze the implications of the Ankle Brachial Index(ABI) on the diagnosis and management of peripheral vascular disease.
  

Click here to start this lesson

Learning Objectives:

• Students should be able to identify infectious diseases, chronic inflammatory conditions, and other collagen vascular diseases related to cardiovascular diseases.
  

Click here to start this lesson

Learning Objectives:

• Students should be able to describe the need to undergo comprehensive risk factor modification for cardiovascular diseases.
  

Click here to start this lesson

Competencies covered in this module:

• General epidemiology and risk factors for asymptomatic disease in various vascular beds. Knowledge of these factors and associations will be helpful to the clinician in determining which patients are at higher versus lower risk to have asymptomatic disease in various vascular beds.
• While controversial as to efficacy, the potential screening modalities for asymptomatic disease in the various vascular beds.
  
• Technical limitations and overall sensitivity, specificity, accuracy, and risks of various screening tests. Radiation exposure from coronary computed tomography angiogram may increase the risk of breast cancer, but the amount of ionizing radiation associated with the test is considerably less than that associated with a stress radionuclide examination. Knowledge of these factors is important for the clinician to weigh the results and risks of such screening tests and determine the need for further testing depending on the overall clinical scenario.
  
• The need for further testing in patients with evidence of asymptomatic disease. This would include the clinical indications for further testing, the methods used for subsequent testing, and their limitations (false positives, false negatives, overall accuracy).
  
• How to treat patients with the presence of asymptomatic disease in various vascular beds, the risks and benefits of these various treatments and interventions, and patient education and knowledge of sources for such educational information (i.e., Web sites, nonprofit organizations).
  
• How to order and/or interpret the above screening tests, understand the test results, explain their meaning to the patient, and plan further testing and treatment, perhaps in consultation with other medical specialists in related areas of vascular medicine.

Learning Objectives:

• Students should learn the general epidemiology and risk factors for asymptomatic disease in various vascular beds and determining which patients are at higher versus lower risk for asymptomatic disease.
  

Click here to start this lesson

Learning Objectives:

• Students should learn the potential screening modalities for asymptomatic disease in various vascular beds.
  

Click here to start this lesson

Learning Objectives:

• Students should learn technical limitations and overall sensitivity, specificity, accuracy, and risks of various screening tests. They should understand that radiation exposure from coronary CT angiogram may increase the risk of breast cancer, but the amount of ionizing radiation associated with the test is considerably less than that associated with a stress radionuclide examination.
  

Click here to start this lesson

Learning Objectives:

• Students should understad the need for further testing in patients with evidence of asymptomatic disease (clinical indications, methods, and their limitations).
  

Click here to start this lesson

Learning Objectives:

• Students should understand how to treat patients with asymptomatic disease, the risks and benefits of these treatments and interventions, and patient education and knowledge of sources for such educational information.
  

Click here to start this lesson

Learning Objectives:

• Students should understand how to order and/or interpret screening tests, understand the results, explain their meaning to the patient, and plan further testing and treatment, with consultation with other medical specialists.
  

Click here to start this lesson

Competencies covered in this module:

• How to measure adherence through a variety of approaches such as history and medication reconciliation.
• How to determine the causal factors underlying nonadherence, including the important patient factors such as health literacy, depression, comorbid conditions, trust in the healthcare provider, adverse effects, and economic factors.
  
• Patient-level interventions to improve adherence such as reducing the cost of medications, treating depression, and use of aids like weekly pill boxes.
  
• Important provider factors such as interest in adherence and skill in identifying barriers to adherence, combined with understanding important healthcare system and societal factors such as ease of maintaining the intervention or medication, cost, systematic reminders, and number and frequency of patient contacts.
  
• Components of a successful disease outcome program such as prompt evaluation and detection of new symptoms and adjustment of medications in response to changes in symptoms; frequency and duration of patient interactions with the disease management program; and mode of collecting information on patient status, including self-reports and automated devices.