The five biggest causes of deaths in America in 2011 included heart disease, chronic lower respiratory diseases, stroke, diabetes and nephritis/nephritic syndrome/nephrosis. All of these causes of death are linked to the circulatory system and the responsibility of primary care physicians (PCPs) to manage among their patients.

The good news is, the causes of these diseases are well known and are largely controllable. Genetics, age, environment, smoking, obesity, lack of exercise and poor diet are some of the most commonly observed reasons for these diseases. However, these “lifestyle” factors can be very difficult to change and PCPs are the ones charged with the responsibility of managing them for their patients.

The 2010 National Ambulatory Medical Care Survey says 35% of patient visits for circulatory problems were made to primary care physicians compared with only 19% to cardiologists. This proves that PCPs are the ones who must find ways to help patients make lifestyle alterations to cope with circulatory disorders or to avoid them altogether.

“We can address obesity, smoking, diet, and sedentary lifestyle, and by so doing, change the course of heart disease,” says Kathy Magliato, MD, FACS, board president of the American Heart Association—Greater Los Angeles division and director of women’s cardiac services at St. John’s Health Center in Santa Monica, California. “That’s where the PCP can have the greatest impact both on the clinical level and the economic level. Because by preventing these illnesses they’re also helping to lower healthcare costs overall.”

The key to minimizing the risk of developing circulatory disorders starts at a young age. According to Centers for Disease Control and Prevention (CDC), 18% of children aged 6-11 and 21% of adolescents aged 12-19 were obese in 2012, up by 7% and 5% respectively compared to 1980. On the whole, 1/3^rd of children and adolescents were overweight or obese. However, the percentage of obese children between the ages of 2 and 5 had fallen to 8.4%, compared with 13.9% in 2003-2004.

Persistence from the PCPs is crucial to helping people suffering from these diseases get on the right track. The discussion may not go anywhere in the first attempt but the second or third time attempt may yield fruitful results. Physicians could ask patients to learn if there are any problems they face which prevent from attainment of their goals. For example, if a patient cannot exercise due to pain in his elbow, the physician could identify exercises that don’t involve usage of the elbow.

Support of family members is crucial for persuading patients to change their lifestyle and sustaining it. A patient looking to lose weight, who does not prepare his /her meals, may need to include his/her spouse in the weight loss program in order to ensure its effectiveness. It works out in the same way for smokers. However, the PCPs must set attainable goals and be patient about achieving them. Overnight changes do not happen so it would be wrong to expect miracles.

Along with counseling, medications remain an integral part of any treatment plan for circulatory-related diseases and conditions.

The range of choices for controlling hypertension, hyperlipidemia, and other conditions has been increasing steadily in recent years. Among the classes of drugs recommended are angiotensin receptor blockers and calcium channel blockers, both of which carry relatively few side effects and are mostly available in generic form, making them more affordable to patients. Thiazide diuretics, while an older class of drugs, remain effective and are very inexpensive.