APPROACH TO IDENTIFYING AND MANAGING CORONARY RISK

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APPROACH TO IDENTIFYING AND MANAGING CORONARY RISK

• Eugene Braunwald, M.D.
• March 6, 2004

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• Prevention of acute events must be the primary
  goal. Treatment should be regarded as locking
  the barn door after the horse is stolen

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• One third of cases of sudden death and acute MI
  occur in previously asymptomatic persons - -
  previously regarded as acts of God
• Most of these are now known to have pre-clinical
  disease, classical or novel risk factors
• Need to identify high risk asymptomatic persons
  prospectively to provide intensive prevention

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• All patients with clinically apparent
  atherosclerotic disease require intensive global
  risk factor reduction
• Some have unstable placques (accidents about to
  happen) and these must be identified

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gt15/yr
Very High Risk
High Risk
2-15/yr
Intermediate Risk
0.5-2/yr
Low Risk
lt0.5/yr
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• Low risk Lifestyle 0.5/yr Follow-u
  p
• (40)
• Framingham Risk Score Intermediate Additional
• CRP, Cholest., Glucose 0.5-2/yr Testing
• (50)
• High risk Intensive
• gt 2/yr global risk ?
• (10)

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• Low risk Risk factor
• ABI
• EBCT
• IMT
• High risk Intensive global non-invasive
• risk detection of
• unstable placque(s)

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• Non-invasive
• Detection novel anti-
  inflammatories
• 25/yr anti-thrombotic Rx
• Very high risk Invasive detection CABG,
  multi
• 15/yr of unstable DES
• 2 placques
• -
• 10/yr continue intensive risk
  factor ?