Asymptomatic Atherosclerosis: Pathophysiology, Detection and Treatment

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Despite recent advances in the diagnosis and treatment of symptomatic atherosclerosis, available traditional screening methods for early detection and treatment of asymptomatic coronary artery disease are grossly insufficient and fail to identify the majority of victims prior to the onset of a life-threatening event. In Asymptomatic Atherosclerosis: Pathophysiology, Detection and Treatment, Dr. Morteza Naghavi and leading authorities from the Society for Heart Attack Prevention and Eradication (SHAPE) present a new paradigm for the screening and primary prevention of asymptomatic atherosclerosis.

The text focuses on accurate, yet underutilized, measures of subclinical atherosclerosis, notably coronary artery calcium scanning and carotid intima-media thickness measurement. The authors introduce a comprehensive approach to identifying the vulnerable patients (asymptomatic individuals at risk of a near future adverse event). Additional chapters discuss future directions towards containing the epidemic of atherosclerotic cardiovascular disease using innovative solutions such as preemptive interventional therapies (bioabsorbable stents) for stabilization of vulnerable atherosclerotic plaques, mass unconditional Polypill therapy for population-based risk reduction, and ultimately vaccination strategies to prevent the development of atherosclerosis.

Up-to-date and authoritative, Asymptomatic Atherosclerosis: Pathophysiology, Detection, and Treatment is a must-have for any cardiologist or primary care physician who wishes to practice modern preventive cardiology and manage the increasing number of asymptomatic atherosclerotic patients.

• Outlines more accurate measures of risk (coronary artery calcium and carotid intima-media thickness) than traditional risk factors (total cholesterol, LDL cholesterol, HDL cholesterol)

• Presents new multipronged strategies to aid in the early detection and treatment of high risk asymptomatic patients

Author(s): Morteza Naghavi (auth.), Morteza Naghavi (eds.)
Series: Contemporary Cardiology
Edition: 1
Publisher: Humana Press
Year: 2011

Language: English
Pages: 737
Tags: Cardiology; Internal Medicine; General Practice / Family Medicine; Primary Care Medicine

Front Matter....Pages i-xxii
Front Matter....Pages 87-87
Preventive Cardiology: The SHAPE of the Future....Pages 1-12
From Vulnerable Plaque to Vulnerable Patient....Pages 13-38
Pathology of Vulnerability Caused by High-Risk (Vulnerable) Arteries and Plaques....Pages 39-51
Pathophysiology of Vulnerability Caused by Thrombogenic (Vulnerable) Blood....Pages 53-66
Vulnerability Caused by Arrhythmogenic Vulnerable Myocardium....Pages 67-76
Approach to Atherosclerosis as a Disease: Primary Prevention Based on the Detection and Treatment of Asymptomatic Atherosclerosis....Pages 77-85
Front Matter....Pages 87-87
History of the Evolution of Cardiovascular Risk Factors and the Predictive Value of Traditional Risk-Factor-Based Risk Assessment....Pages 89-105
Comprehensive Lipid Profiling Beyond LDL....Pages 107-118
New Blood Biomarkers of Inflammation and Atherosclerosis....Pages 119-133
Genomics and Proteomics: The Role of Contemporary Biomolecular Analysis in Advancing the Knowledge of Atherosclerotic Coronary Artery Disease....Pages 135-149
Circulating Endothelial Progenitor Cells: Mechanisms and Measurements....Pages 151-167
Family History: An Index of Genetic and Environmental Predisposition to Coronary Artery Disease....Pages 169-178
Endothelial Activation Markers in Sub-clinical Atherosclerosis: Insights from Mechanism-Based Paradigms....Pages 179-194
Front Matter....Pages 195-195
Exercise Stress Testing in Asymptomatic Individuals and Its Relation to Subclinical Atherosclerotic Cardiovascular Disease....Pages 197-210
The Ankle Brachial Index....Pages 211-223
Arterial Elasticity/Stiffness....Pages 225-235
Assessment of Endothelial Function in Clinical Practice....Pages 237-245
Digital (Fingertip) Thermal Monitoring of Vascular Function: A Novel, Noninvasive, Nonimaging Test to Improve Traditional Cardiovascular Risk Assessment and Monitoring of Response to Treatments....Pages 247-263
Assessment of Macro- and Microvascular Function and Reactivity....Pages 265-275
Front Matter....Pages 277-277
Coronary Artery Calcium Imaging....Pages 279-284
Front Matter....Pages 277-277
Noninvasive Ultrasound Imaging of Carotid Intima Thickness....Pages 285-318
Carotid Intima-Media Thickness: Clinical Implementation in Individual Cardiovascular Risk Assessment....Pages 319-322
Computed Tomographic Angiography....Pages 323-333
Role of Noninvasive Imaging using CT for Detection and Quantitation of Coronary Atherosclerosis....Pages 335-349
Noninvasive Coronary Plaque Characterization: CT Versus MRI....Pages 351-355
Magnetic Resonance Imaging....Pages 357-361
The Role of MRI in Examining Subclinical Carotid Plaque....Pages 363-373
Comprehensive Non-contrast CT Imaging of the Vulnerable Patient....Pages 375-391
Front Matter....Pages 393-393
Ultrasound Assessment of Brachial Artery Reactivity....Pages 395-410
Cardiac Imaging for Ischemia in Asymptomatic Patients: Use of Coronary Artery Calcium Scanning to Improve Patient Selection: Lessons from the EISNER Study....Pages 411-427
Targeted MRI of Molecular Components in Atherosclerotic Plaque....Pages 429-432
Noninvasive Imaging of the Vulnerable Myocardium: Cardiac MRI and CT Based....Pages 433-451
Front Matter....Pages 453-453
Angiography for Detection of Complex and Vulnerable Atherosclerotic Plaque....Pages 455-459
Intravascular Characterization of Vulnerable Coronary Plaque....Pages 461-473
Detecting Vulnerable Plaque Using Invasive Methods....Pages 475-481
Assessment of Plaque Burden and Plaque Composition Using Intravascular Ultrasound....Pages 483-493
Vulnerable Anatomy; The Role of Coronary Anatomy and Endothelial Shear Stress in the Progression and Vulnerability of Coronary Artery Lesions: Is Anatomy Destiny? ....Pages 495-506
Vasa Vasorum Imaging....Pages 507-515
Front Matter....Pages 516-516
From Vulnerable Plaque to Vulnerable Patient – Part III....Pages 517-535
Cost Effectiveness of Screening Atherosclerosis....Pages 537-547
Front Matter....Pages 516-516
Monitoring of Subclinical Atherosclerotic Disease....Pages 549-567
Implications of SHAPE Guideline for Improving Patient Compliance....Pages 569-575
The SHAPE Guideline: Why Primary Care Physicians Should Embrace It....Pages 577-580
Should We Treat According to the SHAPE Guidelines?....Pages 581-586
Duty-Bound: Rational Foundations of Clinical Strategies for Prevention of Cardiovascular Events....Pages 587-596
A Time to Live: Dynamic Changes in Risk as the Basis for Therapeutic Triage....Pages 597-601
Front Matter....Pages 603-603
LDL Targeted Therapies....Pages 605-619
Antioxidants as Targeted Therapy: A Special Protective Role for Pomegranate and Paraoxonases (PONs)....Pages 621-634
The Multiconstituent Cardiovascular Pill (MCCP): Challenges and Promises of Population Based Prophylactic Drug Therapy for Heart Attack Prevention and Eradication....Pages 635-647
Vaccine for Atherosclerosis: An Emerging New Paradigm....Pages 649-657
Front Matter....Pages 659-659
Drug-Eluting Stents: A Potential Preemptive Treatment Choice for Vulnerable Coronary Plaques....Pages 661-669
Intrapericardial Approach for Pancoronary Stabilization of the Vulnerable Arteries and Myocardium....Pages 671-685
Front Matter....Pages 687-687
Dietary Management for Coronary Atherosclerosis Prevention and Treatment....Pages 689-697
Management of Preconditioning Physical Activity in a Vulnerable Patient: Getting in SHAPE....Pages 699-705
Last Chance for Prevention (Acute Prevention): Identification of Prodromal Symptoms and Early Heart Attack Care....Pages 707-722
Back Matter....Pages 723-737