Raimund Erbel
University Duisburg-Essen, Germany
Title: Improved cardiovascular risk prediction using signs of atherosclerosis - Lessons from the Heinz Nixdorf Recall study and Multi-ethnic study of atherosclerosis
Biography
Biography: Raimund Erbel
Abstract
Despite the progress in the diagnosis and treatment of cardiovascular diseases the high frequency of sudden death is thernbiggest challenge today. Sudden and unexpected, acute myocardial infarctions occur even in “healthy” men due to plaquernrupture or erosion based on subclinical coronary atherosclerosis. In relation to the total number of people, who die in therncourse of myocardial infarction, the number of out of hospital deaths reaches two thirds of all deaths. That means, only primaryrnpreventive strategies will be able to reduce this often tragic event, already know in the old Egypt documents. The best noninvasivernmethod in order to detect signs of coronary atherosclerosis is computed tomography (CT), because this technique isrnable to visualize, localize and quantify coronary artery calcification (CAC). Calcium is, on the other hand, found intra- than extracellularly; an early sign of developing coronary atherosclerosis. In men at the age of 40 years, in women 10 years later,rnCAC appears and growths in the following years. CAC quantification is based on the Agatston algorithm. The detection and quantification of CAC helps to identify people at risk nowadays with low x-ray exposure of the patients´ chest. CAC increases during life on an exponential curvature, which allows the prediction of the progression. Due to the remodeling process–rnexhausted at a level of 40-50% of the vessel plaque area - , coronary atherosclerosis remains for decades subclinically until thernplaque load exceeds a level which results in a significant luminal narrowing. In this stage the plaque load has usually reached 70–90 percent of the vessel cross-sectional area. However, not the luminal narrowing, but the plaque rupture or erosion is thernmain reason of the acute events leading to mural or occlusive thrombus formation and in many cases to formation of microembolizationrn resulting in microinfartcs/infarctlets. Therefore, risk reduction based on know signs of coronary atherosclerosis already in the early phase, will help to start a new era of primary prevention.
