Imaging of Coronary Arteries Aid in Prevention of Atherosclerosis and Clinical Coronary Heart Disease

摘要

Prevention of progression of atherosclerosis is the best approach to reduce incidence of myocardial infarction,sudden coronary heart disease (CHD) death, stroke and peripheral vascular disease. Research over the past 40 years hasidentified the risk factors for atherosclerotic disease, noninvasive methods for measuring the extent of atherosclerosis inmultiple vascular beds and very efficacious therapy to reduce the level of risk factors and prevent cardiovascular diseases.Cardiovascular incidence and death rates have declined. Nevertheless, rates of CHD and other vascular disease remainmuch higher in many countries and within select regions of certain countries than necessary. Prevention of atherosclerosisdepends on 4 key steps: 1) a much more aggressive effort to lower modifiable risk factors, especially apolipoprotein-B(ApoB)-containing lipoproteins, low density lipoprotein (LDL) particles, LDL cholesterol, blood pressure, obesity, andsmoking during adolescence and young adult years; 2) identify and treat elevated ApoB lipoproteins, diabetes andsmoking cessation of very high risk young adults as early as possible; 3) use of imaging to identify atherosclerosis ofcoronary and other arteries for appropriate segments of the adult population and treatment of risk factors for those withidentifiable atherosclerosis; and 4) improved approaches to deliver prevention of cardiovascular disease to large numbersof asymptomatic individuals identified by non invasive imaging to maximize adherence to therapies. The major missingpiece is better methods to identify vulnerable coronary plaques on the verge of an atherothrombotic transition and bettertreatments to prevent “acute” events. However, the four steps above will still lead to very substantial reductions in CHDincidence and mortality.