title: Finding the High-Risk Patient in Primary Prevention Is Not as Easy as a Conventional Risk Score!
abstract: Patients with coronary artery disease or its equivalent are an appropriate target for guideline-directed therapy. However, finding and treating the individuals at risk for myocardial infarction or sudden death in primary prevention has been problematic. Most initial cardiovascular events are acute syndromes, and only a minority of these occurs in those deemed high risk by contemporary algorithms. Even newer noninvasive modalities cannot detect a majority of those at risk. Furthermore, accurate and early detection of high risk/vulnerability does not guarantee event prevention. Until new tools can be identified, one should consider a few simplistic solutions. In addition to a greater emphasis on lifestyle, earlier use of statins than currently recommended and a direct assault on tobacco could go a long way in reducing acute syndromes and cardiovascular mortality. To achieve the tobacco goal, the medical community would have to be directly and communally engaged.
authors: University of California, San Francisco, Fresno. Electronic address: jamambrose@yahoo.com.
authors: John A
authors: JA
authors: Ambrose
authors: University of California, San Francisco, Fresno.
authors: Tushar
authors: T
authors: Acharya
authors: University of California, San Francisco, Fresno.
authors: Micah J
authors: MJ
authors: Roberts
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D015415:Biomarkers / Q000032:analysis; D002097:C-Reactive Protein / Q000032:analysis; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging / Q000517:prevention & control*; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000517:prevention & control; D004032:Diet; D015444:Exercise; D005260:Female; D015438:Health Behavior; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000517:prevention & control; D011237:Predictive Value of Tests; D011322:Primary Prevention / Q000379:methods / Q000592:standards*; D018570:Risk Assessment / Q000379:methods; D017678:Sex Distribution; D016540:Smoking Cessation
chemical_list: D015415:Biomarkers; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D002097:C-Reactive Protein
keywords: Cardiovascular disease; Coronary artery disease; Myocardial infarction; Primary prevention