Eighty million adults are affected by heart disease (one in three people) and twenty-five percent of deaths in the United States are due to heart disease. From 1999 to 2009, the cardiovascular disease death rate declined by 33%. However, cardiovascular disease still takes the lives of more than 2,150 Americans each day, an average of 1 death every 40 seconds and is still the number one cause of death. In 2010, coronary artery disease alone was projected to cost the United States $108.9 billion. Most heart attacks occur because of atherosclerotic plaque but, unfortunately, atherosclerosis often remains asymptomatic, delaying treatment until too late. Prevention is key!
The number one killer is still largely preventable. One reason heart attack and stroke are still so prevalent is due to the lack of preventive cardiology training given medical providers worldwide (lack of investment). Preventive cardiology may be described as the aggressive early detection and treatment of cardiovascular conditions such as coronary artery disease and hypertension. Since most atherosclerosis is asymptomatic imaging allows us to detect it in early, preclinical stages, allowing for early intervention. The purpose of this article is to review the imaging most clinically useful to the practitioner, providing scientific support and rationale for use. Only imaging technologies that are the most clinically useful will be emphasized.
The current standard of care does not include detection of asymptomatic atherosclerosis. Instead traditional risk factors are evaluated, the patient is put into a low, medium, or high-risk category and lipid targets are determined by the clinician depending on the category. Thus, coronary artery disease is not detected early. We know that early detection of cancer saves lives. The same is true for atherosclerosis.
A one size fits all approach based only on guidelines leaves some patients over treated and others painfully under treated .
A report based on guidelines initiated by the American Heart Association examining 136,905 patients hospitalized with the diagnosis of CAD revealed the inadequacy of LDL cholesterol HDL cholesterol and triglycerides in identifying high risk patients. The report showed that 77%, 45% and 62% of the patients had normal LDL, HDL and triglycerides respectively. This study confirmed prior suspicions suggesting poor prediction using traditional risk factors (in particular lipids) thus highlighting the shortcomings of existing national cholesterol education program guidelines . This should not be surprising since atherosclerosis is primarily an inflammatory condition and cholesterol is not the sole cause. There are many risk factors.
I help my patients detect treat and reverse or stabilize atherosclerosis. By doing this the majority of heart attacks are prevented.