Atherosclerosis - HDL, ApoA-I, Carotid MRI and 64-slice CT offer opportunities for future treatment

Atherosclerosis generally begins in childhood and manifests clinically in mid-to-late adulthood. While the mortality from atherosclerotic conditions has declined significantly, in developed countries cardiovascular disease accounts for nearly 50% of all deaths, and within the next 15-20 years, is projected to surpass infectious diseases to become the leading cause of death worldwide.

While screening for sub-clinical stages of atherosclerosis could potentially be beneficial in avoiding future cardiovascular events, a barrier to screening for primary prevention is the cost involved in the screening and the implication of identifying somebody at risk being the decision to begin treatment at an early stage.

It would be possible to envision a screening system based on the standard risk factors, blood biomarkers, and non-invasive imaging methods. Such a screening system would identify asymptomatic individuals at high risk. However this would produce the dilemma on whether catheterization should be performed on individuals with no cardiac symptoms.

For patients with atherosclerosis, diagnosis is usually based on coronary angiography. If significant stenosis is detected, treatment consists of PCI or CABG followed by medical management. Although it is widely acknowledged that the benefits of medical therapy are substantial, room for improvement remains, as exemplified by the PROVE-IT study.

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