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APPROACH TO IDENTIFYING AND MANAGING CORONARY RISK

APPROACH TO IDENTIFYING AND MANAGING CORONARY RISK. Eugene Braunwald, M.D. March 6, 2004. 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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APPROACH TO IDENTIFYING AND MANAGING CORONARY RISK

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  1. APPROACH TO IDENTIFYING AND MANAGING CORONARY RISK Eugene Braunwald, M.D. March 6, 2004

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

  3. 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

  4. 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

  5. >15%/yr Very High Risk High Risk 2-15%/yr Intermediate Risk 0.5-2%/yr Low Risk <0.5%/yr

  6. Low risk Lifestyle & 0.5%/yr Follow-up (40%) Framingham Risk Score Intermediate Additional CRP, Cholest., Glucose 0.5-2%/yr Testing (50%) High risk Intensive > 2%/yr global risk  (10%)

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

  8. 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

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