Targeting subclinical atherosclerosis

Has the potential to reduce coronary events dramatically

Afifth of coronary deaths occur in those with no history of ischaemic heart disease, and the absolute number of coronary events is greater in the low risk population than in high risk groups. Risk scores cannot predict nearly half the future episodes of coronary heart disease.1The prevention of these acute events remains a major challenge.

Primary prevention, including health promotion in the community and multiple risk factor screening, has generally been disappointing2—major problem has been that people have found it difficult to change their lifestyles. On the other hand, some trials of single risk factor screening followed by medical treatment, rather than lifestyle changes, have shown a significant reduction in vascular events. For example, in the West of Scotland Coronary Prevention Study screening and treating high serum cholesterol concentrations in 45-64 year old men led to a 31% reduction in cardiovascular …