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Adult Cardiovascular Disease Prevention

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  • Adult Cardiovascular Disease Prevention Homepage


     3214

    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.

    • Module 1: Introduction to Preventive Cardiology

      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.
      • Module1: Lesson 1: Introduction to Preventive Cardiology

        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

        3 URLs
        • Required Learning Resources and Activities
        • 2016 European Guidelines on cardiovascular disease prevention in clinical practice. URL

          Read section 1.1"What is Cardiovascular Disease Prevention? Definition and rationale". It is a brief introduction to the importance of preventive cardiology in clinical practice. (2 minutes)

          Oxford University Press - 2016

        • Setting the Agenda for Preventive Cardiology URL

          Read the entire article.(17 minutes)

          American Heart Association, Inc. - 2017

        • Primary prevention of cardiovascular disease: A review of contemporary guidance and literature URL

          Read the entire article.(29 minutes)

          National Center for Biotechnology Information, U.S. National Library of Medicine, National Institutes of Health - 2017

      • Module1: Lesson 2: Approach to Cardiac Patient

        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

        1 URL
        • Required Learning Resources and Activities
        • Introduction to the Approach to the Cardiac Patient URL

          Read the web page. Then, click on the link tiled "cardiovascular examination" for a stepwise exam protocol. (22 minutes)

          Merck Sharp & Dohme Corp. - 2016

        • Quiz: Module 1
          Restricted Not available unless: The activity Pre-Test is marked complete

          To access the quiz, click on the name of the quiz provided above. On the following screen, click the "Preview quiz now" button to respond to the questions.

      • Module 2: Cardiovascular and Vascular Biology

        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.
        • Module 2: Lesson 1: Atherosclerosis

          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

          3 URLs
          • Required Learning Resources and Activities
          • What is atherosclerosis URL

            Read the section entitled, "What is" for a picture representation of the atherosclerosis. You may optionally read the rest of the article for a better overview of atherosclerosis, its causes signs and symptoms, diagnosis and management. (3 minutes)

            National Heart, Lung, and Blood Institute 

          • Atherosclerosis . URL

            Read from the beginning of the page until the beginning of the section titled "Risk Factors". The rest of the web page is considered optional reading". (9 minutes)

            Merck Sharp & Dohme Corp. - 2017

          • Recommended Additional Readings

          • Endothelial Cell Dysfunction and the Pathobiology of Atherosclerosis URL

            Read the entire article. ( 68 minutes)

            Circulation Research - AHA/ASA Journal - 2016

        • Module 2: Lesson 2: Disorders of Lipid Metabolism

          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

          3 URLs
          • Required Learning Resources and Activities
          • Overview of Lipid Metabolism URL

            Read the entire article. ( 5 minutes)

            Merck Sharp & Dohme Corp. - 2018

          • Atherosclerosis . URL

            Read the title "Risk Factors". (15 minutes)

            McMaster Pathophysiology Review - 2012

          • The Treatment of Disorders of Lipid Metabolism URL

            Read the entire article. (30 minutes)

            National Center for Biotechnology Information, U.S. National Library of Medicine, National Institutes of Health - 2016

        • Module 2: Lesson 3: Plaques and their Roles

          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

          4 URLs
          • Required Learning Resources and Activities
          • Mechanisms of Plaque Formation and Rupture URL

            Read the sections titled "Mechanisms of Plaque Formation", "Mechanisms of Plaque Rupture, Erosion and Thrombosis", "Plaque Burden", "Plaque Activity", and "Plaque Vulnerability". (52 minutes.

            American Heart Association, Inc. - 2014

          • Atherosclerotic Plaque Rupture Identifying the Straw That Breaks the Camel’s Back URL

            Read the entire article for more in-depth overview of plaque rupture. (30 minutes)

            American Heart Association, Inc. - 2016

          • Carotid plaque fissure: An underestimated source of intraplaque hemorrhage URL

            Read section "1. Introduction".(2 minutes)

            National Center for Biotechnology Information, U.S. National Library of Medicine, National Institutes of Health - 2016

          • Recommended Additional Readings

          • Watch, Learn and Live - Interactive Cardiovascular Library URL

            Read the content of the web page. Then, click on the link titled "Next" to see the progression of atherosclerosis from the "Normal Artery Wall" to the formation of an "Occlusion". (5 minutes)

            American Heart Association, Inc. 

        • Module 2: Lesson 4: Neurohormonal Derangements

          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

          8 URLs
          • Required Learning Resources and Activities
          • The Endocrine System and the Heart: A Review URL

            Read the entire article. (43 minutes)

            Sociedad Española de Cardiología - 2011

          • Environmental factors in cardiovascular disease URL

            Read the abstract and key points. (3 minutes)

            Springer Nature Publishing AG - 2015

          • Social Determinants of Risk and Outcomes of Cardiovascular Disease: A Scientific Statement From the American Heart Association URL

            Read the entire article. (98 minutes)

            American Heart Association, Inc. - 2015

          • Cardiovascular Disease and Its Determinants: Public Health Issue URL

            Read the entire article. ( 20 minutes)

            iMedPub LTD - 2017

          • Antihypertensive Drugs and Fibrinolytic Function: Impact of Dual Calcium Channel and Renin-Angiotensin System Blockade URL

            Read the introductory paragraph as well as the section titled "The Fibrinolytic System". (4 minutes)

            Oxford University Press - 2006

          • Hormones of the Cardiovascular System URL

            Read the entire chapter. Due to the inability to read Figure 4, the diagram is not needed, however the paragraph on endothelin is sufficient for information. (12 minutes)

            National Center for Biotechnology Information, U.S. National Library of Medicine, National Institutes of Health - Updated 2015 Feb 6

          • Recommended Additional Readings

          • Neurohumors and Neurohormones: Definitions and Terminology URL

            Read the subsection titled "(2) Neurohormones" found under the heading titled "Summary". (2 minutes)

            Springer International Publishing AG. Part of Springer Nature. - 1969

          • Neurohormones and the Progression of Cardiovascular Disease: What's Behind High Risk? URL

            Read the entire article. (16)

            The American Journal of Managed Care, Clinical Care Targeted Communications Group, LLC - 2004

        • Module 2: Lesson 5: Pharmacological Interventions

          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

          5 URLs
          • Required Learning Resources and Activities
          • Atherosclerosis: Treatment URL

            Read section titled "Treatment". (10 minutes)

            Merck Manuals - Updated March 2017

          • Therapeutic approaches to drug targets in atherosclerosis URL

            Read the entire article. (18 minutes)

            Elsevier B.V - 2014

          • Cholesterol Lowering Drugs URL

            Read the entire chapter. (142 minutes)

            National Center for Biotechnology Information, U.S. National Library of Medicine, National Institutes of Health - 2018

          • Recommended Additional Readings

          • Cholesterol Drugs URL

            Read the content of the web page. Then, go through the interactive presentation by pressing the link titled "Next". (5 minutes)

            American Heart Association, Inc.

          • Stabilization of high-risk plaques URL

            Read the entire article. (32 minutes)

            National Center for Biotechnology Information, U.S. National Library of Medicine, National Institutes of Health - 2016

        • Module 2: Lesson 6: Non-pharmacological Interventions

          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

          1 URL
          • Required Learning Resources and Activities
          • Evidence of Lifestyle Modification in the Management of Hypercholesterolemia URL

            Read the entire article. Important figures to note are Figure 1, and Table 3. (51 minutes)

            National Center for Biotechnology Information, U.S. National Library of Medicine, National Institutes of Health - 2013

          • Quiz: Module 2
            Restricted Not available unless: The activity Quiz: Module 1 is marked complete

            To access the quiz, click on the name of the quiz provided above. On the following screen, click the "Preview quiz now" button to respond to the questions.

        • Module 3: Clinical Epidemiology and Biostatistics

          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.
          • Module 3: Lesson 1: Central tendency and Magnitude of Dispersion

            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

            5 URLs
            • Required Learning Resources and Activities
            • Measures of central tendency: The mean URL

              Read the section titled "central tendency". (1 minute)

              National Center for Biotechnology Information, U.S. National Library of Medicine, National Institutes of Health - 2011

            • What is Central Tendency? URL

              Read the entire webpage. (12 minutes)

              Rice University - 2012

            • Measures of Central Tendency URL

              Read the entire webpage. (5 minutes)

              Rice University - 2012

            • Percentiles. URL

              Read the entire webpage. (7 minutes)

              Rice University - 2012

            • In Brief: Standard Deviation and Standard Error URL

              Read the entire article. (13 minutes)

              National Center for Biotechnology Information, U.S. National Library of Medicine, National Institutes of Health - 2011

          • Module 3: Lesson 2: Screening and Diagnostic Tests

            Learning Objectives:

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

            Click here to start this lesson

            2 URLs
            • Required Learning Resources and Activities
            • Screening tests: a review with examples URL

              Read Introduction, Definitions. (51 minutes)

              National Center for Biotechnology Information, U.S. National Library of Medicine, National Institutes of Health - 2014

            • Sensitivity, Specificity, and Predictive Values: Foundations, Pliabilities, and Pitfalls in Research and Practice URL

              Read the entire article. (18 minutes)

              National Center for Biotechnology Information, U.S. National Library of Medicine, National Institutes of Health - 2017

          • Module 3: Lesson 3: Study Designs and Hypothesis Testing

            Learning Objectives:

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

            Click here to start this lesson

            4 URLs
            • Required Learning Resources and Activities
            • Study designs. URL

              Read the entire article. (15 minutes)

              National Center for Biotechnology Information, U.S. National Library of Medicine, National Institutes of Health - 2010

            • Research study designs: Non-experimental URL

              Read the entire article. (30 minutes)

              Elsevier Inc - 2007

            • Research study designs: Experimental and quasi-experimental URL

              Read the entire article. (25 minutes)

              Elsevier Inc - 2006

            • Biostatistics Series Module 2: Overview of Hypothesis Testing URL

              Read the entire article. (53 minutes)

              National Center for Biotechnology Information, U.S. National Library of Medicine, National Institutes of Health - 2016

          • Module 3: Lesson 4: Common Analyses

            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

            4 URLs
            • Required Learning Resources and Activities
            • T test as a parametric statistic URL

              Read the sections titled "Abstract" and "Introduction". (2012)

              National Center for Biotechnology Information, U.S. National Library of Medicine, National Institutes of Health - 2015

            • ANOVA, Regression, and Chi-Square URL

              Read the entire page. You may click on "Instructor's notes" for more explanations. (13 minutes)

              University of Connecticut

            • A Practical Guide to Understanding Kaplan-Meier Curves URL

              Read the entire article. (28 minutes)

              National Center for Biotechnology Information, U.S. National Library of Medicine, National Institutes of Health - 2010

            • Statistical notes for clinical researchers: Type I and type II errors in statistical decision URL

              Read the entire article. (14 minutes)

              National Center for Biotechnology Information, U.S. National Library of Medicine, National Institutes of Health - 2015

          • Module 3: Lesson 5: Risk Factors and Inflammatory Biomarkers

            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

            2 URLs
            • Required Learning Resources and Activities
            • The Role of Emerging Risk Factors in Cardiovascular Outcomes URL

              Read entire article which outlines the different inflammatory biomarkers and emerging risk factors associated with stroke and coronary artery disease. (35 minutes)

              National Center for Biotechnology Information, U.S. National Library of Medicine, National Institutes of Health - 2017

            • Relative risk versus absolute risk: one cannot be interpreted without the other URL

              Read the entire article. (30 minutes)

              Oxford University Press - 2017

          • Module 3: Lesson 6: Relative and Absolute Risk

            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

            2 URLs
            • Required Learning Resources and Activities
            • Relative risk versus absolute risk: one cannot be interpreted without the other URL

              Read the entire article. (30 minutes)

              Oxford University Press - 2017

            • Framingham Risk Score (FRS) URL

              Examine the entire worksheet. (4 minutes)

              Canadian Cardiovascular Society - 2017

          • Module 3: Lesson 7: Cost-benefit Analysis of CVD interventions

            Learning Objectives:

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

            Click here to start this lesson

            1 URL
            • Required Learning Resources and Activities
            • "Cost-effectiveness of interventions to control cardiovascular diseases and diabetes mellitus in South Asia: a systematic review" URL

              Read the entire article. The tables are considered optional reading. (20 minutes)

              BMJ Publishing Group Ltd. - 2018

            • Quiz: Module 3
              Restricted Not available unless: The activity Quiz: Module 2 is marked complete

              To access the quiz, click on the name of the quiz provided above. On the following screen, click the "Preview quiz now" button to respond to the questions.

          • Module 4: Cardiovascular Pharmacology

            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.
            • Module 4: Lesson 1: Pharmacological Approaches to CVD Prevention

              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

              10 URLs
              • Required Learning Resources and Activities
              • Drugs for Hypertension URL

                Read the entire article. Click on the links for more information on the specific drugs and dosage. (30 minutes)

                Merck Sharp & Dohme Corp. - 2018

              • The Canadian Cardiovascular Society's Dyslipidemia Guidelines URL

                Read slides 9-16 for the pharmacological approach to treating dyslipidemia. Students may read the booklet in its entirety for more background information. (15 minutes)

                Canadian Cardiovascular Society - 2016

              • Deep Vein Thrombosis (DVT) URL

                Read the entire article to gain a better understanding of DVT, in particular on the section titled "Treatment". (33 minutes)

                Merck Sharp & Dohme Corp. - 2018

              • Newer P2Y12 Inhibitors: How Does the Interventional Cardiologist Choose? URL

                Read the entire article. (11 minutes)

                American Heart Association - 2016

              • Glycemic Management in Adults With Type 1 Diabetes URL

                Read the entire article. (32 minutes)

                Elsevier Inc - 2018

              • Pharmacologic Glycemic Management of Type 2 Diabetes in Adults URL

                Read the entire article. (52 minutes)

                Elsevier Inc - 2018

              • "2018 Clinical Practice Guidelines Quick Reference Guide" URL

                Read the entire booklet. It has a nice summary of screening and diagnosis and as well as proper treatment for diabetes. (48 minutes)

                Diabetes Canada - 2018

              • Smoking Cessation . URL

                Read the entire article. Click on the links for more information on the specific drugs and dosage. (20 minutes)

                Merck Sharp & Dohme Corp. - 2018

              • Obesity . URL

                Read the section titled "Treatment". The rest of the article is considered optional reading. (12 minutes)

                Merck Sharp & Dohme Corp. - 2018

              • Recommended Additional Readings

              • Final Recommendation Statement: Tobacco Smoking Cessation in Adults, Including Pregnant Women: Behavioral and Pharmacotherapy Interventions URL

                Read the entire recommendation statement. (52 minutes)

                U.S. Preventive Services Task Force - 2015

            • Module 4: Lesson 2: Drug Combinations and Interactions

              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

              3 URLs
              • Required Learning Resources and Activities
              • Multifactorial Prevention of Cardiovascular Disease in Patients with Hypertension: the Cardiovascular Polypill URL

                Read the entire article. (45 minutes)

                National Center for Biotechnology Information, U.S. National Library of Medicine, National Institutes of Health - 2016

              • Combination therapy in the treatment of hypertension URL

                Read the entire article. (27 minutes)

                National Center for Biotechnology Information, U.S. National Library of Medicine, National Institutes of Health - 2018

              • Drug-Drug Interactions of Common Cardiac Medications and Chemotherapeutic Agents URL

                Read entire article. (19 minutes)

                American College of Cardiology - 2018

            • Module 4: Lesson 3: Preventive Cardiovascular Strategies for Comorbidities

              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

              6 URLs
              • Required Learning Resources and Activities
              • AHA/ACC/HHS Strategies to Enhance Application of Clinical Practice Guidelines in Patients With Cardiovascular Disease and Comorbid Conditions URL

                Read the entire article. (50 minute)

                Journal of the American College of Cardiology - 2014

              • Cardiovascular co-morbidity in cancer patients: the role of psychological distress URL

                Read the entire article. (25 minutes)

                BioMed Central Ltd - 2016

              • Shared Risk Factors in Cardiovascular Disease and Cancer URL

                Read the entire article. (42 minutes)

                American Heart Association Inc. - 2016

              • Strategies to manage cardiovascular risk in chronic kidney disease URL

                Read the entire article. (10 minutes)

                Oxford University Press - 2018

              • Cardiovascular Involvement in Autoimmune Diseases URL

                Read entire article, especially the tables that provide a good summary of CVD risk factors and various autoimmune diseases. (84 minutes)

                National Center for Biotechnology Information, U.S. National Library of Medicine, National Institutes of Health - 2014

              • Primary Prevention of Cardiovascular Disease in Diabetes Mellitus URL

                Read the entire article. Especially take note of the Central Illustration. (22 minutes)

                Jonathan D.Newman, Arthur Z. Schwartzbard, Howard S.Weintrau DaIra J.Goldberg, Jeffrey S.Berger - 2017

            • Module 4: Lesson 4: Pharmacologic Dosing Adjustments

              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

              7 URLs
              • Required Learning Resources and Activities
              • Clinical pharmacology relevant to older adults with cardiovascular disease URL

                Read the entire article. (14 minutes)

                National Center for Biotechnology Information, U.S. National Library of Medicine, National Institutes of Health - 2015

              • Cardiac drug therapy—considerations in the elderly URL

                Read the entire article. This primarily focuses on dosing adjustments. (30 minutes)

                National Center for Biotechnology Information, U.S. National Library of Medicine, National Institutes of Health - 2016

              • Pharmacokinetics in Older Adults URL

                Read the entire article. (6 minutes)

                Merck Sharp & Dohme Corp. - 2018

              • Gender differences in the effects of cardiovascular drugs URL

                Read the entire article. (69 minutes)

                Oxford University Press - 2017

              • The role of racial/ethnic factors in global clinical trials URL

                Read section 1 titled "Race and ethnicity: consideration of impacts on pharmacotherapeutics". (10 minutes)

                2018 Informa UK Limited - 2018

              • Drug prescription appropriateness in the elderly: an Italian study URL

                Read the entire article. (32 minutes)

                National Center for Biotechnology Information, U.S. National Library of Medicine, National Institutes of Health - 2017

              • 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: : The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) URL

                Read section 11 titled "Comorbidities". (51 minutes)

                Oxford University Press - 2016

            • Module 4: Lesson 5: Pharmacological Interactions

              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

              7 URLs
              • Required Learning Resources and Activities
              • Use of over the counter products in older cardiovascular patients admitted to a tertiary care center in USA URL

                Read the entire article. (24 minutes)

                National Center for Biotechnology Information, U.S. National Library of Medicine, National Institutes of Health - 2018

              • Grapefruit Juice and Statins URL

                Read the entire article. (14 minutes)

                Elsevier Inc. - 2016

              • The role of nutraceuticals in the prevention of cardiovascular disease URL

                Read the entire article. (25 minutes)

                National Center for Biotechnology Information, U.S. National Library of Medicine, National Institutes of Health - 2017

              • Herbal Medications in Cardiovascular Medicine URL

                Read the entire article. (40 minutes)

                Elsevier Inc. - 2017

              • The role of nutraceuticals in the prevention of cardiovascular disease URL

                Read the entire article. (37 minutes)

                National Center for Biotechnology Information, U.S. National Library of Medicine, National Institutes of Health - 2017

              • Major Cereal Grain Fibers and Psyllium in Relation to Cardiovascular Health URL

                Read "Abstract" and Section 4: Arabinoxylan which talks mainly about psyllium and its effects in cardiology. (5 minutes)

                National Center for Biotechnology Information, U.S. National Library of Medicine, National Institutes of Health - 2013

              • Dietary Fiber, Atherosclerosis, and Cardiovascular Disease URL

                Read the sections titled "Abstract", "1. Introduction". "5. Fiber, Blood Cholesterol, and Atherosclerosis" and "7. Summary". (15 minutes)

                MDPI (Basel, Switzerland) - 2019

            • Module 4: Lesson 6: Pharmacogenomics

              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

              1 URL
              • Required Learning Resources and Activities
              • Pharmacogenetics in Cardiovascular Medicine URL

                Read the entire article. (19 minutes)

                National Center for Biotechnology Information, U.S. National Library of Medicine, National Institutes of Health - 2016

              • Quiz: Module 4
                Restricted Not available unless: The activity Quiz: Module 3 is marked complete

                To access the quiz, click on the name of the quiz provided above. On the following screen, click the "Preview quiz now" button to respond to the questions.

            • Module 5: Genetics and Cardiovascular Disease in Individuals and Families

              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.
              • Module 5: Lesson 1: Proper Cardiovascular History-Taking

                Learning Objectives:

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

                Click here to start this lesson

                2 URLs
                • Required Learning Resources and Activities
                • Approach to the Cardiac Patient URL

                  Read Introduction to Approach to the Cardiac Patient. Click on the links to Cardivascular examination for a step-wise exam. (15 minutes)

                  Merck Sharp & Dohme Corp. - 2019

                • Teaching history taking to medical students: a systematic review URL
              • Module 5: Lesson 2: Genetic Terms and Inheritance

                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

                4 URLs
                • Required Learning Resources and Activities
                • What is inheritance? URL

                  Read entire page. It has a good introduction to the definitons of genetic terms: inheritance, genotype, phenotype, Mendelian inheritance. Students can click on links to get a detailed definition of terms. (15 minutes)

                  Wellcome Genome Campus - 2017

                • What are dominant and recessive alleles? URL

                  Read entire page. Students can click on links to get a detailed definition of terms. (15 minutes)

                  Wellcome Genome Campus - 2016

                • What are reduced penetrance and variable expressivity? URL

                  Read entire page. (5 minutes)

                  Genetics Home Reference (National Library of Medicine) - 2017

                • What is Inheritance? URL

                  Read entire page. Click on video for more information. (20 minutes)

                  University of Utah (Genetic Science Learning Centre) - 2017

              • Module 5: Lesson 3: Clinical Genetics

                Learning Objectives:

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

                Click here to start this lesson

                2 URLs
                • Required Learning Resources and Activities
                • Genes, Behavior, and the Social Environment: Moving Beyond the Nature/Nurture Debate: Genetics and Health URL

                  Read Chapter 3: Genetics and Health. On right side panel, there is a table of contents - click on Genetic Linkage Analysis and Genetic Association Studies. Another subtitle is Aspects of Health Influenced by Genetics which has a section on CVD. Students may read the entire chapter for more indepth information. (60 minutes)

                  National Academies Press - 2006

                • Genome-Wide Association Studies URL

                  Read entire page. (30 minutes)

                  National Human Genome Research Institute - 2015

              • Module 5: Lesson 4: Chromosomal Abnormalities

                Learning Objectives:

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

                Click here to start this lesson

                12 URLs
                • Required Learning Resources and Activities
                • Chromosomes URL

                  Read entire page. (30 minutes)

                  National Human Genome Research Institute - 2015

                • Chromosome Abnormalities URL

                  Read entire page. (30 minutes)

                  National Human Genome Research Institute - 2016

                • Overview of Chromosomal Anomalies URL

                  Read entire page. (30 minutes)

                  Merck Sharp & Dohme Corp. - 2016

                • Down Syndrome (Trisomy 21) URL

                  Read entire page. (15 minutes)

                  Merck Sharp & Dohme Corp. - 2016

                • Edwards Syndrome (Trisomy 18) URL

                  Read entire page. (5 minutes)

                  Merck Sharp & Dohme Corp. - 2016

                • Patau Syndrome (Trisomy 13) URL

                  Read entire page. (5 minutes)

                  Merck Sharp & Dohme Corp. - 2016

                • Chromosomal Deletion Syndromes URL

                  Read entire page. (5 minutes)

                  Merck Sharp & Dohme Corp. - 2016

                • Microdeletion Gene Syndromes URL

                  Read entire page. (2 minutes)

                  Merck Sharp & Dohme Corp. - 2016

                • Overview of Sex Chromosome Anomalies URL

                  Read the first 2 paragraphs as an introduction to sex chromosome anomalies. (2 minutes)

                  Merck Sharp & Dohme Corp. - 2016

                • Turner Syndrome URL

                  Read entire page. (7 minutes)

                  Merck Sharp & Dohme Corp. - 2016

                • Klinefelter Syndrome (47,XXY) URL

                  Read entire page. (5 minutes)

                  Merck Sharp & Dohme Corp. - 2016

                • Recommended Additional Readings

                • Chromosomal Abnormalities URL

                  Read entire page. Click on each abnormality for an indepth understanding of its genetics and pathology. (30 minutes)

                  University of Utah (Genetic Science Learning Centre) - 2017

              • Module 5: Lesson 5: Mendelian Disorders and Syndromes Associated with Congenital Heart Disease and Connective Tissues Disorders

                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

                4 URLs
                • Required Learning Resources and Activities
                • Mendelian Genetic Disorders URL

                  Read entire article. Important to review Table 4. (45 minutes)

                  Encyclopedia of Life Sciences - 2005

                • Genetics of Congenital Heart Disease URL

                  Read entire article. (45 minutes)

                  Current Cardiology Reviews - 2010

                • Aortic Disease in the Young: Genetic Aneurysm Syndromes, Connective Tissue Disorders, and Familial Aortic Aneurysms and Dissections URL

                  Read entire article. (30 minutes)

                  International Journal of Vascular Medicine - 2013

                • Recommended Additional Readings

                • Connective Tissue Disorders and Cardiovascular Complications: The indomitable role of Transforming Growth Factor-beta signaling URL

                  Read entire article. (45 minutes)

                  Advances in Experimental Medicine and Biology - 2014

              • Module 5: Lesson 6: Cardiomyopathies, Arrhythmias and Lipoprotein Disorders

                Learning Objectives:

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

                Click here to start this lesson

                8 URLs
                • Required Learning Resources and Activities
                • What Is Cardiomyopathy in Adults? URL

                  Read entire page. Students can click on links to get a detailed definition of the types of cardiomyopathies. (10 minutes)

                  American Heart Association - 2016

                • The genetics of dilated cardiomyopathy URL

                  Read entire article. (20 minutes)

                  Current Opinion in Cardiology - 2010

                • Genetics and genomics of dilated cardiomyopathy and systolic heart failure URL

                  Read entire article. (20 minutes)

                  Genome Medicine - 2017

                • About Arrhythmia URL

                  Read entire page. Students can click on links to get a detailed overview of the types of arrhythmia. (30 minutes)

                  American Heart Association - 2016

                • Interactive Video: Arrhythmia URL

                  Students can click on the drop down menu on the left hand side and select the different types of arrhyhmias to see a visual representation. (15 minutes)

                  American Heart Association - 2017

                • Genetic Basis of Lipoprotein Disorders URL

                  Read entire article. (20 minutes)

                  American Heart Association - 1995

                • Lipid Storage Diseases Fact Sheet URL

                  Read entire article. (35 minutes)

                  National Institute of Neurological Disorders and Stroke - 2005

                • Genetic testing in cardiovascular diseases URL

                  Read entire article. (20 minutes)

                  Current Opinion in Cardiology - 2014

              • Module 5: Lesson 7: Teratogens

                Learning Objectives:

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

                Click here to start this lesson

                8 URLs
                • Required Learning Resources and Activities
                • What is a teratogen? URL

                  Read both sections entiitled: What is a teratogen? And What are the most senstive periods for teratogens in pregnancy? (10 minutes)

                  Children's Hospital of Wisconsin - 2017

                • Fetal warfarin syndrome. URL

                  Read entire article. (15 minutes)

                  Chang Ghung Medical Journal - 2004

                • Fetal Hydantoin Syndrome URL

                  Read entire page. (20 minutes)

                  National Organization of Rare Diseases - 2015

                • Fetal Retinoid Syndrome URL

                  Read entire page. (20 minutes)

                  National Organization of Rare Diseases - 2003

                • Congenital Rubella Syndrome (CRS) URL

                  Read entire page. (15 minutes)

                  The Embryo Project (associated with Arizona State University) - 2014

                • Fetal Alcohol Syndrome (FAS) URL

                  Read entire page. (15 minutes)

                  The Embryo Project (associated with Arizona State University) - 2014

                • Recommended Additional Readings

                • Retinoids As Teratogens URL

                  Read entire page. (15 minutes)

                  The Embryo Project (associated with Arizona State University) - 2014

                • Teratogenic mechanisms of medical drugs URL

                  Read entire article. (40 minutes)

                  Human Reproduction Update - 2010

              • Module 5: Lesson 8: Genetic Testing

                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

                8 URLs
                • Required Learning Resources and Activities
                • What are the benefits of genetic testing? URL

                  Read entire page. (5 minutes)

                  Genetics Home Reference (National Library of Medicine) - 2017

                • What are the risks and limitations of genetic testing? URL

                  Read entire page. (5 minutes)

                  Genetics Home Reference (National Library of Medicine) - 2017

                • Genetic testing and screening URL

                  Read entire page. (20 minutes)

                  Government of Canada - 2013

                • Genetic Testing . URL

                  Read entire page and students can watch the video presentation as well. (10 minutes)

                  Stanford Medicine: Centre for Inherited Cardiovascular Health

                • Direct-to-consumer genetic testing kits URL

                  Read entire article. (20 minutes)

                  Harvard Health Publishing: Harvard Medical School - 2010

                • Genetic Counseling In Depth URL

                  Read entire page. (20 minutes)

                  Stanford Medicine: Centre for Inherited Cardiovascular Health

                • Genetic Testing for Early Detection of Individuals at Risk of Coronary Heart Disease and Monitoring Response to Therapy: Challenges and Promises URL

                  Read entire article. (45 minutes)

                  Current Artherosclerosis Reports - 2011

                • Genetic testing in cardiovascular diseases URL

                  Read entire article. (20 minutes)

                  Current Opinion in Cardiology - 2014

                • Quiz: Module 5
                  Restricted Not available unless: The activity Quiz: Module 4 is marked complete

                  To access the quiz, click on the name of the quiz provided above. On the following screen, click the "Preview quiz now" button to respond to the questions.

              • Module 6: Behavioural and Psychosocial Programs

                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.

                • Module 6: Lesson 1: Psychosocial Effects in Cardiovascular Disease

                  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

                  3 URLs
                  • Required Learning Resources and Activities
                  • Psychological factors and coronary heart disease URL

                    Read entire article. (30 minutes)

                    2013

                  • The epidemiology, pathophysiology, and management of psychosocial risk factors in cardiac practice: The emerging field of behavioral cardiology URL

                    Read entire article. (60 minutes)

                    2004

                  • Impact of Psychological Factors on the Pathogenesis of Cardiovascular Disease and Implications for Therapy URL

                    Read entire article. (60 minutes)

                    1999

                • Module 6: Lesson 2: Anxiety and Depression Disorders

                  Learning Objectives:

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

                  Click here to start this lesson

                  6 URLs
                  • Required Learning Resources and Activities
                  • Anxiety Disorders URL

                    Students may read entire page. Main topics include: Overview, Signs and Symptoms, Risk Factors and Treatment/Therapies. (45 minutes)

                    2016

                  • Depression. URL

                    Students may read entire page. Main topics include: Overview, Signs and Symptoms, Risk Factors and Treatment/Therapies. (45 minutes)

                    2016

                  • Suicidal Ideation in the Family Medicine Clinic URL

                    Read entire commentary. (30 minutes)

                    2016

                  • Practical Suicide-Risk Management for the Busy Primary Care Physician URL

                    Read entire article. (30 minutes)

                    2011

                  • Appropriateness of GP referrals of patients with anxiety and depression URL

                    Students should click on the PDF icon on the left hand side of the title for access of the full article. Another link for the article is below. Read entire article. (25 minutes

                    2011

                  • Recommended Additional Readings

                  • Diagnosing and Treating Mood Disorders in the Primary Care Setting URL

                    Watch entire lecture. (59.42 minutes)

                    2010

                • Module 6: Lesson 3: Pharmacotherapies

                  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

                  5 URLs
                  • Required Learning Resources and Activities
                  • The pharmacological management of depression URL

                    Read entire article. Students should understand it is a good introduction to pharmacotherapy. (30 minutes)

                    2005

                  • Treatment of Childhood and Adolescent Depression URL

                    Read entire article. (35 minutes)

                    2012

                  • Common Questions About the Pharmacologic Management of Depression in Adults URL

                    Read entire article. (35 minutes)

                    2015

                  • Pharmacologic treatment of depression in the elderly URL

                    Read entire article. (30 minutes)

                    2014

                  • Guidelines for the Management of Depression During Pregnancy URL

                    Read entire article. (20 minutes)

                    2010

                • Module 6: Lesson 4: Safe Treatments in CVD

                  Learning Objectives:

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

                  Click here to start this lesson

                  3 URLs
                  • Required Learning Resources and Activities
                  • How Should We Treat Depression in Patients with Cardiovascular Disease? URL

                    Read entire article. (30 minutes)

                    2012

                  • Cardiovascular Considerations in Antidepressant Therapy: An Evidence-Based Review URL

                    Read entire article. (30 minutes)

                    2013

                  • Treatment of anxiety and depressive disorders in patients with cardiovascular disease URL

                    Read entire article. ( 30 minutes)

                    2004

                • Module 6: Lesson 5: Proper Use of Referrals

                  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

                  1 URL
                  • Required Learning Resources and Activities
                  • Appropriateness of GP referrals of patients with anxiety and depression URL

                    Students should click on the PDF icon on the left hand side of the title for access of the full article. Another link for the article is below. Read entire article. (25 minutes)

                    2011

                • Module 6: Lesson 6: Cardiac Rehabilitation

                  Learning Objectives:

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

                  Click here to start this lesson

                  3 URLs
                  • Required Learning Resources and Activities
                  • Cardiac rehabilitation URL

                    Read entire article. Students may listen to the two recordings present on the site as well. (30 minutes)

                    2015

                  • Psychosocial Screening and Assessment Practice within Cardiac Rehabilitation: A Survey of Cardiac Rehabilitation Coordinators in Australia URL

                    Read entire article. (35 minutes)

                    2017

                  • Psychosocial Outcomes of an Exercise Maintenance Intervention After Phase II Cardiac Rehabilitation URL

                    Read entire article. (40 minutes)

                    2014

                • Module 6: Lesson 7: Role of Healthcare Systems in CVD

                  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

                  2 URLs
                  • Required Learning Resources and Activities
                  • New Developments in Understanding Cardiovascular Disease and the Implications for Social Work URL

                    Read entire article. (45 minutes)

                    2007

                  • Cardiac Rehabilitation: Psychosocial Support URL

                    Read entire chapter 9. (30 minutes)

                    2003

                  • Quiz: Module 6
                    Restricted Not available unless: The activity Quiz: Module 5 is marked complete

                    To access the quiz, click on the name of the quiz provided above. On the following screen, click the "Preview quiz now" button to respond to the questions.

                • Module 7: Advanced Risk Assessment (Renal, Inflammatory Disease)

                  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.

                  • Module 7: Lesson 1: Urinary Albumin Creatinine Ratio

                    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

                    4 URLs
                    • Required Learning Resources and Activities
                    • "Urine Albumin and Albumin/Creatinine Ratio" URL

                      Read entire page. ( 15 minutes)

                      2015

                    • Identification and Management of Albuminuria in the Primary Care Setting URL

                      Read entire article. (45 minutes)

                      2011

                    • Microalbuminuria and Cardiovascular Disease URL

                      Read entire article. (35 minutes)

                      2007

                    • Recommended Additional Readings

                    • Microalbuminuria and Risk for Cardiovascular Disease: Analysis of Potential Mechanisms URL

                      Read entire article. (30 minutes)

                      2006

                  • Module 7: Lesson 2: Erectile Dysfunction and CVD

                    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

                    2 URLs
                    • Required Learning Resources and Activities
                    • Erectile dysfunction and cardiovascular disease URL

                      Read entire article. (30 minutes)

                      2013

                    • Cardiovascular Implications of Erectile Dysfunction URL

                      Read entire article. (25 minutes)

                      2011

                  • Module 7: Lesson 3: Ankle-Brachial Index

                    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

                    2 URLs
                    • Required Learning Resources and Activities
                    • Measuring and Understanding the Ankle Brachial Index (ABI) URL

                      Read entire page. Student can click on the videos for a visual representation. (30 minutes)

                      2017

                    • Measurement and Interpretation of the Ankle-Brachial Index URL

                      Students can read the entire article for supplementary information. However, an important section to read is "ABI: A Marker for CVD Risk and Events". (60 minutes)

                      2012

                  • Module 7: Lesson 4: Comprehensive Risk Factor Modification

                    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

                    4 URLs
                    • Required Learning Resources and Activities
                    • Emerging Risk Factors for Atherosclerotic Vascular Disease: A Critical Review of the Evidence URL

                      Read entire article. (60 minutes)

                      2003

                    • Who Is at Risk for Atherosclerosis? URL

                      Read entire page. (30 minutes)

                      2016

                    • Infection and Atherosclerosis Development URL

                      Read entire article. (30 minutes)

                      2015

                    • A New Paradigm of Cardiovascular Risk Factor Modification URL

                      Read entire article. (30 minutes)

                      2005

                  • Module 7: Lesson 5: Aggressive Management in Patients with Chest Wall Irradiation

                    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

                    2 URLs
                    • Required Learning Resources and Activities
                    • Cardiovascular complications of radiation therapy for thoracic malignancies: the role for non-invasive imaging for detection of cardiovascular disease URL

                      Read entire article. (35 minutes)

                      2013

                    • Radiation induced heart disease: Pathogenesis, management and review literature URL

                      Read entire article. (40 minutes)

                      2015

                    • Quiz: Module 7
                      Restricted Not available unless: The activity Quiz: Module 6 is marked complete

                      To access the quiz, click on the name of the quiz provided above. On the following screen, click the "Preview quiz now" button to respond to the questions.

                  • Module 8: Subclinical Atherosclerosis Assessment

                    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.

                    • Module 8: Lesson 1: General Epidemiology and Risk Factors for Asymptomatic Disease

                      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

                      6 URLs
                      • Required Learning Resources and Activities
                      • Screening for Peripheral Artery Disease URL

                        Read entire article. Students should consider this as a brief introduction to PAD screening. (20 minutes)

                        2012

                      • "Improving Coronary Heart Disease Risk Assessment in Asymptomatic People: Role of Traditional Risk Factors and Noninvasive Cardiovascular Tests" URL

                        Read entire article. (40 minutes)

                        2001

                      • Abdominal Aortic Diameter and the Risk for Asymptomatic Peripheral Arterial Disease in Patients with Type 2 Diabetes URL

                        Read entire article. (35 minutes)

                        2015

                      • Society for Vascular Surgery practice guidelines for atherosclerotic occlusive disease of the lower extremities: Management of asymptomatic disease and claudication URL

                        Read the following sections: Epidemiology and risk factors. (10 minutes)

                        2014

                      • ACCF/AHA 2007 Clinical Expert Consensus Document on Coronary Artery Calcium Scoring by Computed Tomography in Global Cardiovascular Risk Assessment and in Evaluation of Patients With Chest Pain URL

                        Click on "Risk Assessment for Coronary Heart Disease in Asymptomatic Populations" in the outline menu, and read until the start of the title "Role of CAC Scoring in Assessment of Symptomatic Patients". (30 minutes)

                        2007

                      • Co-existence of vascular disease in different arterial beds: Peripheral artery disease and carotid artery stenosis URL

                        Read entire article. (30 minutes)

                        2015

                    • Module 8: Lesson 2: Screening Modalities for Asymptomatic Disease

                      Learning Objectives:

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

                      Click here to start this lesson

                      3 URLs
                      • Required Learning Resources and Activities
                      • Screening for asymptomatic cardiovascular disease with noninvasive imaging in patients at high-risk and low-risk according to the European Guidelines on Cardiovascular Disease Prevention: The SMART study URL

                        Read entire article. (35 minutes)

                        2006

                      • Screening for Atherosclerotic Vascular Diseases:: Should Nationwide Programs Be Instituted? URL

                        Read entire article. (40 minutes)

                        2008

                      • "Asymptomatic Carotid Stenosis: Screening and Management" URL

                        Read entire article. (40 minutes)

                        2011

                    • Module 8: Lesson 3: Results and Risks of Screening Tests

                      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

                      3 URLs
                      • Required Learning Resources and Activities
                      • Sensitivity and Specificity of the Ankle–Brachial Index to Predict Future Cardiovascular Outcomes URL

                        Read entire article. (35 minutes)

                        2005

                      • Radiation Dose From Cardiac Computed Tomography Before and After Implementation of Radiation Dose–Reduction Techniques URL

                        Read entire article. (30 minutes)

                        2009

                      • Defining a Rational Approach to Screening for Cardiovascular Risk in Asymptomatic Patients URL

                        Read entire article. (25 minutes)

                        2008

                    • Module 8: Lesson 4: Further Testing in Asympatomic Disease

                      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

                      5 URLs
                      • Required Learning Resources and Activities
                      • Determining the Role of Subclinical Disease Testing in Patients at Intermediate Risk URL

                        Read entire page. (40 minutes)

                        2004

                      • Common Reasons That Asymptomatic Patients Who Are 65 Years and Older Receive Carotid Imaging URL

                        Read entire article. (35 minutes)

                        2016

                      • Exercise Treadmill Test in Detecting Asymptomatic Coronary Artery Disease in Type 2 Diabetes Mellitus URL

                        Read entire article. (35 minutes)

                        2016

                      • An Evidence-Based Guide for Coronary Calcium Scoring in Asymptomatic Patients without Coronary Heart Disease URL

                        Read entire article. (35 minutes)

                        2012

                      • Patient Self-Referral for Radiologic Screening Tests: Clinical and Ethical Concerns URL

                        Read entire article. (30 minutes)

                        2003

                    • Module 8: Lesson 5: Treatment in Asympatomatic Disease

                      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

                      5 URLs
                      • Required Learning Resources and Activities
                      • Society for Vascular Surgery practice guidelines for atherosclerotic occlusive disease of the lower extremities: Management of asymptomatic disease and claudication URL

                        Read the following sections: 3. Management of asymptomatic patients with PAD, 4. Noninterventional management of the patient with IC, 5. The role of revascularization for IC, 6. Surveillance after revascularization for IC. (35 minutes)

                        2014

                      • Appropriate management of asymptomatic carotid stenosis URL

                        Read entire article. (30 minutes)

                        2016

                      • Peripheral Arterial Disease: Public and Patient Awareness in the Netherlands URL

                        Read entire article. (30 minutes)

                        2004

                      • Heart and Vascular Disease: Prevention Tips URL

                        Read entire page. (10 minutes)

                      • Vascular Health Screening URL

                        Read entire page. (10 minutes)

                        2016

                    • Module 8: Lesson 6: Communicating to the Patient

                      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

                      4 URLs
                      • Required Learning Resources and Activities
                      • Vascular Screening URL

                        Read entire article. (15 minutes)

                        2013

                      • Heart-Health Screenings URL

                        Read entire page. (15 minutes)

                        2017

                      • Test result communication in primary care: clinical and office staff perspectives URL

                        Read entire article. (20 minutes)

                        2014

                      • Recommended Additional Readings

                      • Multidisciplinary approach to the diagnosis and management of patients with peripheral arterial disease URL

                        Read entire article. (30 minutes)

                        2015

                      • Quiz: Module 8
                        Restricted Not available unless: The activity Quiz: Module 7 is marked complete

                        To access the quiz, click on the name of the quiz provided above. On the following screen, click the "Preview quiz now" button to respond to the questions.

                    • Module 9: Adherence and Disease Outcome Interdisciplinary Programs

                      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.