Next Steps in Primary Prevention of Coronary Heart Disease: Rationale for and Design of the ECAD Trial.
Atherosclerotic cardiovascular disease (ASCVD) events, including coronary heart disease and stroke, are the most frequent cause of death and major disability in the world. Current American College of Cardiology/American Heart Association primary prevention guidelines are mainly on the basis of randomized controlled trials of statin-based low-density lipoprotein cholesterol (LDL-C)-lowering therapy for primary prevention of ASCVD events. Despite the clear demonstration of statin-based LDL-C lowering, substantial 10-year and lifetime risks of incident ASCVD continue. Although the 10-year risk is low in young and middle-aged adults who would not be treated according to current guidelines, they ultimately account for most incident ASCVD. If statin-based LDL-C lowering were initiated in them at an age before complex coronary plaques are common in the population, a substantial reduction in lifetime risk of incident coronary heart disease might be achieved. We examine this hypothesis and introduce the design of a currently recruiting trial to address it. (Eliminate Coronary Artery Disease [ECAD]; NCT02245087).
Icahn School of Medicine at Mount Sinai, New York, New York; Heart and Stroke/Richard Lewar Centre of Excellence, University of Toronto, Toronto, Ontario, Canada; Peter Munk Cardiac Centre, University of Toronto, Toronto, Ontario, Canada. Electronic address: michael.domanski@uhn.ca.
Michael J
MJ
Domanski
Icahn School of Medicine at Mount Sinai, New York, New York; Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain.
Valentin
V
Fuster
Advanced Medical Research Institute of Canada, Sudbury, Ontario, Canada.
Francisco
F
Diaz-Mitoma
University of Texas, Southwestern University Medical School at Dallas, Dallas, Texas.
Scott
S
Grundy
Northwestern University Medical School, Chicago, Illinois.
Donald
D
Lloyd-Jones
Applied Health Research Centre, Li Ka Shing Knowledge Institute, University of Toronto, Ontario, Canada.
Muhammad
M
Mamdani
McMaster University, Hamilton, Ontario, Canada.
Robin
R
Roberts
Applied Health Research Centre, Li Ka Shing Knowledge Institute, University of Toronto, Ontario, Canada.
Kevin
K
Thorpe
Applied Health Research Centre, Li Ka Shing Knowledge Institute, University of Toronto, Ontario, Canada.
Judith
J
Hall
Heart and Stroke/Richard Lewar Centre of Excellence, University of Toronto, Toronto, Ontario, Canada; Peter Munk Cardiac Centre, University of Toronto, Toronto, Ontario, Canada; Women's College, Peter Munk Centre, Research Institute and Cardiovascular Division, Department of Medicine, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada.
Jacob A
JA
Udell
Icahn School of Medicine at Mount Sinai, New York, New York; Heart and Stroke/Richard Lewar Centre of Excellence, University of Toronto, Toronto, Ontario, Canada; Peter Munk Cardiac Centre, University of Toronto, Toronto, Ontario, Canada.
Michael E
ME
Farkouh
D000328:Adult; D058070:Asymptomatic Diseases; D008078:Cholesterol, LDL / Q000097:blood / Q000187:drug effects*; D003327:Coronary Disease / Q000097:blood / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D018579:Patient Selection; D058226:Plaque, Atherosclerotic / Q000517:prevention & control*; D011322:Primary Prevention / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D012107:Research Design; D018570:Risk Assessment; D012307:Risk Factors
D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
atherosclerosis; atherosclerotic; cholesterol; hydroxymethylglutaryl-CoA reductase inhibitors; plaque; primary prevention