Real Time Atherosclerosis Assessment in Outpatient Cardiology Practice Along With Cardiovascular Risk Assessment and Physician Patient Communication: A Three-Pronged Approach for Patient Risk Evaluation, Education, and Treatment

摘要

Despite implementation of risk factor-based screening, deaths due to cardiovascular disease (CVD) continue to rise. The majority of CVD deaths occur in those with low to intermediate Framingham risk score (FRS). Risk based algorithms have served women particularly poorly. Imaging based methods of atherosclerosis [i.e. coronary calcium scan (CAC) and carotid intima media thickness (IMT) with plaque assessment] have proven to riskstratify patients better and often demonstrate presence of atheroscIerosis in those with Iow FRS; however CAC and IMT have been given cIass Ilb and cIass III indication respectiveIy for CVD risk stratification. A shift in the IiberaIization of statin therapy serves the popuIation better; however is stiII IikeIy to undertreat some with and over treat others without atheroscIerosis. Moreover, Iimited patientphysician diaIogue on CVD prevention, unknown risk factors, side effects from therapy and Iack of patient motivation remain barriers to impIementation of preventive treatment.