Atherosclerosis is a Treatable Condition

Our understanding of atherosclerosis has markedly improved over the last 5 to 10 years.  The traditional risk factors for this condition are well-described and include:

These risk factors contribute to the development of plaque formation in the wall of the arteries as early as the first decade of life.  If these risk factors go untreated, atherosclerosis progresses and can ultimately lead to progressive blockage of arteries or heart attack and stroke.

However, 80% of heart attacks can be explained by at least one of the risk factors listed above.  We know what causes atherosclerosis!  Therefore, we have the opportunity to largely prevent this disease.  Even in patients with established atherosclerosis, intensive treatment of multiple risk factors can stabilize or even reverse the disease.

Our ability to target individuals without clinical disease, but with high risk, is also improving.  Many new lab tests are now available which can be incorporated into risk models or aid clinical judgment.  These include markers of vascular inflammation (high sensitivity CRP, lipoprotein-associated phospholipase A2,) markers of increased clotting (fibrinogen, homocysteine,) and lipoprotein measurements (NMR, lipoprotein(a).)

Imaging tests such as carotid ultrasound to measure wall thickness, CT scan to measure calcium in the wall of heart arteries, and CT angiography allow for “a window” through which we can peer to detect the disease as it develops.

We now can develop specific, risk-reducing strategies to combat this disease.  It is no longer necessary to treat everyone the same way to prevent cardiovascular disease.  At the Center for Cardiovascular Disease Prevention, we aim to detect and quantify your risk, educate you about the nature of that risk, and work with you to minimize the clinical endpoints (heart attack, stroke, amputation) associated with that risk.

“Bypass surgery or transluminal angioplasty provide rational and often effective therapies for these fixed, high-grade stenoses (narrowings.)  However, these treatments do not address the nonstenotic but vulnerable plaque.  It is of interest in this regard that despite the well-accepted benefits of coronary bypass surgery on anginal symptoms, this treatment aimed at severe stenoses does not prevent myocardial infarction.  To reduce the risk of acute myocardial infarction, one must stabilize lesions to prevent this disruption, particularly the less stenotic plaque.”