Yes. The promise of cardiovascular disease prevention is finally here. Optimal cholesterol treatment can modify the plaque itself causing plaque stabilization, slowing progression, preventing rupture and even causing regression. The result is a reduction of cardiovascular events not matched by any other form of therapy.

Yes. All cardiologists should be preventive. How can this be accomplished?

EDITORIAL COMMENT

Time to End the Mixed—and Often Incorrect—Messages About Prevention and Treatment of Atherosclerotic Cardiovascular Disease

Philip Greenland, MD and Donald Lloyd-Jones, MD, ScM

Departments of Preventive Medicine and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.

Prologue

Medical research has revealed enough about the causes and prevention of heart attacks that they could be nearly eliminated. Yet nearly 16 million Americans are living with coronary heart disease, and nearly half a million die from it each year. It’s not that prevention doesn’t work, and it’s not that once someone has a heart attack there is little to be done. In fact, said Dr. Elizabeth Nabel, director of the National Heart, Lung and Blood Institute at the National Institutes of Health, age-adjusted death rates for heart disease dropped precipitously in the past few decades, and prevention and better treatment are major reasons why. But the concern, Dr. Nabel and others say, is that much more could be done. In many ways, scientists’ hard-won and increasingly detailed understanding of what causes heart disease and what to do for it often goes unknown or ignored.

J Am Coll Cardiol, 2007; 50:2133-2135, doi:10.1016/j.jacc.2007.05.055 (Published online 12 November 2007).

Coronary Heart Disease Mortality Among Young Adults in the U.S. From 1980 Through 2002

Concealed Leveling of Mortality Rates

Earl S. Ford, MD, MPH and Simon Capewell, MD

Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Department of Public Health, University of Liverpool, Liverpool, United Kingdom.

Excerpts:

The trends for mortality from CHD among U.S. adults age 35 to 54 years are disquieting. The EAPC slowed markedly from 1980 to 2002 in both men and women. Particularly noteworthy is that the mortality rate among women age 35 to 44 years has been increasing on average by 1.3% (95% CI 0.2 to 2.5) per year since 1997.

Conclusions: The mortality rates for CHD among younger adults may serve as a sentinel event. Unfavorable trends in several risk factors for CHD provide a likely explanation for the observed mortality rates.