Clinical meaning
Preventive medicine at the advanced practice level requires understanding the molecular mechanisms underpinning screening and intervention strategies. Statin therapy for primary cardiovascular prevention inhibits HMG-CoA reductase in hepatocytes, upregulating LDL receptor expression and reducing circulating atherogenic lipoprotein particles that drive endothelial injury and plaque formation. GLP-1 receptor agonists used in obesity pharmacotherapy act on pancreatic beta cells to enhance glucose-dependent insulin secretion while simultaneously acting on hypothalamic appetite centers to reduce caloric intake. Varenicline for tobacco cessation is a partial agonist at the alpha-4-beta-2 nicotinic acetylcholine receptor, providing enough dopamine release to reduce cravings while blocking the rewarding effects of nicotine if the patient resumes smoking.
Diagnosis & workup
Diagnostics & workup: - Low-dose CT chest: annual for adults 50-80 with 20 or more pack-year history who currently smoke or quit within past 15 years - PSA testing: shared decision-making for men aged 55-69, not routinely recommended after age 70 - DEXA scan: women 65 and older, men 70 and older, or younger with risk factors; FRAX calculator for treatment decisions - Lipid panel with ASCVD risk calculator to guide statin initiation threshold - Comprehensive STI screening: HIV, syphilis, gonorrhea, chlamydia based on risk factors and population guidelines - First trimester combined screening, NIPT, anatomy ultrasound at 18-22 weeks, GDM screening at 24-28 weeks - Hepatitis B and C screening per USPSTF recommendations - AAA screening with one-time abdominal ultrasound for men aged 65-75 who have ever smoked