How to avoid a heart attack: putting it all together.

Cardiovascular disease (eg, myocardial infarction, ischemic stroke) is the leading cause of death in patients who have metabolic syndrome and diabetes mellitus. By effectively treating the whole patient, however, the risk of death from cardiovascular disease can be reduced or prevented. The author describes clinical approaches for achieving this goal. He reviews information that is useful to know about patients regarding modifiable and potentially modifiable risk factors for cardiovascular disease, including hypertension, hyperlipidemia, smoking, activity levels, dietary habits, obesity, carotid artery stenosis, and atrial fibrillation. He also notes the importance of evaluating patients for relevant psychosocial factors such as depression. Finally, the author analyzes treatment options for patients, including effective medications, dietary modification, and exercise-emphasizing the use of pedometers-as well as participation by patients in weight-control support groups.