Abstract
Billions of dollars have been spent over the past 25 years on developing new therapies
for the prevention/treatment of adverse cardiac events related to atherosclerotic
cardiovascular disease. Although some therapies have been lifesaving, several mega-randomized
studies have shown only a <2% absolute reduction in adverse events with a large residual
event rate. Is all this money well spent? Atherosclerosis develops decades before
an adverse event, and the trials previously alluded to have nearly always been applied
to secondary prevention, decades after disease initiation. Will earlier intervention
result in a lower incidence of events? Individuals with an absence of the usual cardiac
risk factors have a lifelong low incidence of events. Early initiation of strategies
against the common cardiovascular risk factors in primary or primordial prevention
will lower the incidence of adverse events, although many groups have not been well
studied, including individuals younger than 40 years of age. New strategies are required
to realize a radical reduction in events, and this article proposes new methods of
prevention/treatment for coronary artery disease complications.
Keywords
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Article info
Publication history
Published online: May 02, 2018
Accepted:
April 3,
2018
Received in revised form:
April 3,
2018
Received:
March 14,
2018
Footnotes
☆Funding: None.
✯✯Conflicts of Interest: None.
✯Authorship: The authors take full responsibility for the content of the article. Both authors had access to the data and a role in writing this manuscript.
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© 2018 Published by Elsevier Inc.
