William E Feeman Jr.
Wood County Hospital, USA
Title: Enhanced prediction of the population at risk of atherothrombotic disease
Biography
Biography: William E Feeman Jr.
Abstract
Statement of the Problem: To be able to prevent atherothrombotic disease (ATD), one must be able to predict the population at risk of ATD. Many risk predictors have been advocated for such prediction, but none have been universally accepted.
Methodology & Theoretical Orientation: The Framingham Heart Study has demonstrated that the population that develops ATD differs from the population that does not by the severity of certain ATD risk factors and the duration during which those risk factors have been operative. The author has examined his entire ATD population to determine the constellation of ATD risk factors that separates population from the population that did not develop some form of clinical ATD.
Findings: The population at risk of ATD is characterized by cigarette smoking, dyslipidemia, and (often) hypertension, with some contribution from the very high blood sugar levels of uncontrolled diabetes. These risk factors are not independent, but rather dependent, interacting with one another leading to ATD. Dyslipidemia is defined as a ratio between LDL- and HDL-cholesterol (Cholesterol Retention Fraction, or CRF, defined as [LDL-HDL]/LDL). The predictive tool is a graph with the CRF on the ordinate and systolic blood pressure (SBP) on the abscissa. The graph exhibits a threshold line with CRF-SBP co-ordinates (0.74, 100) and (0.49, 140), above which lie the CRF-SBP of 93% of all the ATD patients in the author’s practice. Further fine-tuning can be done by stratifying the CRF by SBP or by LDL-cholesterol. Any therapy that brings the CRF-SBP plot below the threshold line results in plaque stabilization/regression in a minimum average of 75% of cases.
Conclusions: The population at risk of ATD is predictable and hence, ATD is preventable.