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

Abstract

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 has identified the risk factors for atherosclerotic disease, noninvasive methods for measuring the extent of atherosclerosis in multiple 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 remain much higher in many countries and within select regions of certain countries than necessary. Prevention of atherosclerosis depends 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, and smoking during adolescence and young adult years; 2) identify and treat elevated ApoB lipoproteins, diabetes and smoking cessation of very high risk young adults as early as possible; 3) use of imaging to identify atherosclerosis of coronary and other arteries for appropriate segments of the adult population and treatment of risk factors for those with identifiable atherosclerosis; and 4) improved approaches to deliver prevention of cardiovascular disease to large numbers of asymptomatic individuals identified by non invasive imaging to maximize adherence to therapies. The major missing piece is better methods to identify vulnerable coronary plaques on the verge of an atherothrombotic transition and better treatments to prevent “acute” events. However, the four steps above will still lead to very substantial reductions in CHD incidence and mortality.

Coronary Artery Calcification (CAC) and Post‐Trial Cardiovascular Events and Mortality Within the Women's Health Initiative (WHI) Estrogen‐Alone Trial

“…The power to evaluate associations with incident events, especially when stratified by prior randomization to CEE‐Alone versus placebo, is limited by the low rates of CHD, CVD, and CVD mortality. These low event rates are related to the very low prevalence of CAC (ie, 54% of the women had CAC=0 and 62% had CAC <10), consistent with other studies showing much lower prevalence of coronary calcification in women than men, and very low incidence of CHD and CVD in both men and women with low CAC scores . Finally, while presence and severity of CAC is strongly associated with the overall atherosclerotic plaque burden, it does not quantify noncalcified plaque, and may also represent inflammation or other determinants of tissue calcification .…”

“…Noninvasive imaging for coronary artery calcification was performed with the use of electron‐beam or multidetector‐row CT at the 28 participating centers, as previously described . A standardized protocol was used to obtain phantom and test images . At a central reading center at Wake Forest University, the Agatston scores were calculated at a computer workstation by experienced image analysts using established criteria, and without knowledge of randomization status .…”

Subclinical Cardiovascular Disease and Death, Dementia, and Coronary Heart Disease in Patients 80+ Years

“…(1–5) Women have lower incidence of clinical CHD than men even at older ages and less coronary atherosclerosis as measured by CAC. (4,6,7) Women also have first heart attack at older age than men; about 72 in women and mid 60s in men. (8) The extent of subclinical coronary atherosclerosis is a very powerful predictor of risk of clinical coronary artery disease (CAD), CHF, and stroke.…”

“…(8) The extent of subclinical coronary atherosclerosis is a very powerful predictor of risk of clinical coronary artery disease (CAD), CHF, and stroke. (6,9–13) A zero CAC Agatston score is associated with very long term lower risk of CHD and death even at older ages. (14)…”

Development of Innovative Biomaterials and Devices for the Treatment of Cardiovascular Diseases

“…[ 7 ] Pharmacological‐based treatments are effective in the early stages of CHD by control of blood pressure and cholesterol levels, but are usually insufficient once the disease evolved into severe stages. [ 8 ] CHD treatment was achieved through coronary artery bypass grafting, especially for patients with multivascular disease. [ 9 ] However, in recent decades, it has been surpassed by use of percutaneous coronary intervention (PCI), accompanied with continuous technology development, especially with the wide application of cardiovascular stents, which will be systematically reviewed hereunder.…”