Long term prognostic value for a normal CCTA

Alalawi, Luay; Budoff, Matthew J.

doi:10.1016/j.jcct.2022.07.006

Cited by 3 publications

(2 citation statements)

References 18 publications

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“…Considerable recent data in individuals with normal—meaning plaque-free—coronary CTA scans at baseline indicate nearly event-free survival for 5 to 10 years. 135,136 These findings, along with studies showing remarkably low ASCVD event rates in people who have low lifetime levels of LDLc, 119,160–164 suggest what might be possible on a broad scale. Of course, none of these studies was performed in individuals with recently healed plaques.…”

Section: Efforts To Prevent—or To Find and Treat—early Arterial Diseasementioning

confidence: 93%

“…Imaging can provide a meaningful end point that is potentially achievable in a few years, 13,78 just as in other clinical trials, even in younger individuals who do not have terminal, end-stage arterial disease. Based on our earlier proposals, 24,78 plus more recently published information, 61,131,132,135,136 the approach should be simple.…”

Section: "[W]e Ought To Be In a Position To Figure Out Ways To Preven...mentioning

confidence: 99%

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Eradicating Atherosclerotic Events by Targeting Early Subclinical Disease: It Is Time to Retire the Therapeutic Paradigm of Too Much, Too Late

Williams

2024

ATVB

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Recent decades have seen spectacular advances in understanding and managing atherosclerotic cardiovascular disease, but paradoxically, clinical progress has stalled. Residual risk of atherosclerotic cardiovascular disease events is particularly vexing, given recognized lifestyle interventions and powerful modern medications. Why? Atherosclerosis begins early in life, yet clinical trials and mechanistic studies often emphasize terminal, end-stage plaques, meaning on the verge of causing heart attacks and strokes. Thus, current clinical evidence drives us to emphasize aggressive treatments that are delayed until patients already have advanced arterial disease. I call this paradigm too much, too late. This brief review covers exciting efforts that focus on preventing, or finding and treating, arterial disease before its end-stage. Also included are specific proposals to establish a new evidence base that could justify intensive short-term interventions (induction-phase therapy) to treat subclinical plaques that are early enough perhaps to heal. If we can establish that such plaques are actionable, then broad screening to find them in early midlife individuals would become imperative—and achievable. You have a lump in your coronaries! can motivate patients and clinicians. We must stop thinking of a heart attack as a disease. The real disease is atherosclerosis. In my opinion, an atherosclerotic heart attack is a medical failure. It is a manifestation of longstanding arterial disease that we had allowed to progress to its end-stage, despite knowing that atherosclerosis begins early in life and despite the availability of remarkably safe and highly effective therapies. The field needs a transformational advance to shift the paradigm out of end-stage management and into early interventions that hold the possibility of eradicating the clinical burden of atherosclerotic cardiovascular disease, currently the biggest killer in the world. We urgently need a new evidence base to redirect our main focus from terminal, end-stage atherosclerosis to earlier, and likely reversible, human arterial disease.

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