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M. Dominique Ashen, CRNP, PhD

Ciccarone Center Research

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M. Dominique Ashen, CRNP, PhD

M. Dominique Ashen, CRNP, PhD
Ashen, M. Dominique, CRNP, PhD

Dominique Ashen, CRNP, PhD, is the Nurse Practitioner Coordinator for the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease. She also has a joint appointment in the Johns Hopkins University School of Nursing where she teaches nurse practitioner students.

Landmark Article

Comparison of breast cancer recurrence risk and cardiovascular disease incidence risk among postmenopausal women with breast cancer.

By: Bardia A, Arieas ET, Zhang Z, Defilippis A, Tarpinian K, Jeter S, Nguyen A, Henry NL, Flockhart DA, Hayes DF, Hayden J, Storniolo AM, Armstrong DK, Davidson NE, Fetting J, Ouyang P, Wolff AC, Blumenthal RS, Ashen MD, Stearns V.
Competing comorbidities, particularly cardiovascular disease (CVD), should be considered when individualizing adjuvant therapies for postmenopausal women diagnosed with breast cancers. Among postmenopausal women with hormone receptor-positive (HR+), non-metastatic breast cancer, the majority had a predicted 10-year CVD risk that was equivalent to or higher than breast cancer recurrence risk. Physicians should weigh competing risks and offer early screening and cardiac prevention strategies for women at a greater risk for CVD.

Comprehensive lipid management in the coronary artery disease patient.

By: Amin NP, Blaha MJ, Chow GV, Blumenthal RS, Ashen MD.

Low-density lipoprotein cholesterol (LDL-C) is the lipoprotein most implicated in atherosclerosis, and aggressive statin therapy remains the cornerstone of treatment. Adjunct therapies are often required to reach LDL-C goals, and recent studies have only fueled the debate over ezetimibe versus niacin. Alternate dosing regimens of high-potency statins can be used in those who cannot tolerate side effects. Residual risk may remain after LDL-C goals are achieved. Non–high-density lipoprotein cholesterol (non–HDL-C) must be calculated in patients with elevated triglycerides. Omega-3 fatty acids are most effective in lowering non–HDL-C. Low HDL-C levels can be raised with niacin, but clinical events may not be significantly reduced. Newer therapeutic targets, such as cholesteryl ester transfer protein (CETP) inhibitors, raise HDL-C and are being evaluated for safety and efficacy. Several ongoing, randomized controlled trials are investigating the relative efficacy of adjunctive therapies for reducing coronary heart disease events in high-risk patients.

Cost-effective prevention of coronary heart disease.

By: Ashen MD.

Healthcare designed to prevent future illness and minimize progression of current illness is a powerful means to improve quality of life, minimize mortality, and decrease health care costs. Coronary heart disease (CHD) is the #1 killer of both men and women in the United States. Prevention of CHD involves early identification and management of risk factors through assessment and treatment. The goal in CHD prevention is to produce the largest relative risk reduction, the smallest number needed to treat, and the lowest cost per quality-adjusted life year saved. Evidence-based treatment strategies have been shown to cost-effectively minimize CHD risk and reduce morbidity and mortality. Approaches that encompass the lifespan, solidify assessment and treatment strategies in the primary care setting, and reach into the workplace, schools, churches, and homes to make small changes in risk factors across an entire population are important areas for improving CHD preventive care. Public health policies are also necessary to support implementation of preventive programs.

Prevention of coronary heart disease: risk assessment, treatment strategies and the role of prevention in cost-effective health care.

By: Ashen, MD.

Evidence-based guidelines for cardiovascular risk reduction: The safety and efficacy of high-dose statin therapy.

By: Ashen MD, Foody JM.
Suboptimal use of statins by patients who remain at an unnecessarily increased risk of CV disease may be explained by concerns over the safety and efficacy of high-dose statin regimens in certain populations. These issues are explored in the context of current, evidence-based clinical guidelines for low-density lipoprotein-cholesterol (LDL-C) management and, through 3 hypothetical case studies, selection of appropriate starting doses of statins, and titration to a higher dose or switching to a more potent statin, to ensure that patients reach their individual LDL-C goals and reduce their overall CV risk, is also examined.