From Vulnerable Plaque to Vulnerable Patient Our Mission Is Eradication of Heart Attack

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From Vulnerable Plaque to Vulnerable Patient
Our Mission Is Eradication of Heart Attack

• Morteza Naghavi, M.D.Founder and President,
• Association for Eradication of Heart Attack (AEHA)

The AEHA VP Summit An American Heart
Association 2005 Satellite Symposium
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• Heart attack is NOT the worlds number one
  problem, extreme poverty is.

The AEHA 2005 VP Summit
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Extreme Poverty Is a Shame to the World

• 50,000 per day die of infectious diseases which
  could almost all be cured or prevented at a cost
  which is sometimes no more than 1 per person

World Health Organization
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Extreme Poverty Is a Shame to the World
Much Kudus to Bono and the One Campaign
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After extreme poverty and associated infectious
diseases, eradication of heart attack can be the
most rewarding opportunity in the 21st century
for saving productive life years worldwide.
The AEHA 2005 VP Summit
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How the World Dies Today?
AtheroscleroticDiseases
YLLs Years of Life Lost
The AEHA 2005 VP Summit
World Health Organization
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Worldwide Causes of Death Source WHO
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gt 15 Million Heart Attacks Each Year
Source World HeartFederation
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DEATHS FROM CARDIOVASCULAR CAUSES WORLDWIDE
Western countries Non-Western (developing)
countries
Over 2/3 of the global burden of heart attack and
stroke is on poor countries.
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gt25m tomorrow
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6 million
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15m today
Millions of Deaths from Cardiovascular Causes
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19 million
5 million
10
5
9 million
0
1990
2020
KS Reddy. NEJM 2004 3502438
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More than half caused by a sudden heart attack in
healthy- looking population
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Epidemic of Heart Failure
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Global Epidemic of Diabetes
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Epidemic of Obesity Diabetes in the U.S.
1990/1991
2000
Obesity
No Data
lt 10
10-14
15-19
³ 20
Diabetes
Mokdad et al., JAMA 28611951200, 2001
No Data
lt 4
4-6
gt 6
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Global Atherosclerosis A Bigger Threat than
Global Warming!
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Prevent Attack!

• Heart attack is not equal to heart disease, and
  is not equal to atherosclerosis either. It is
  the attack part of coronary heart disease that is
  most devastating, and the first focal point of
  the AEHA movement.

Heart attack is the tip of atherosclerosis
problem.
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From Vulnerable Plaque to Vulnerable PatientWhat
have we learned in the past 5 years.

• More than one vulnerable plaque exists and
  rupture prone plaques are not the only type of
  vulnerable plaques. Besides plaque, blood and
  myocardial vulnerability must be considered.
• Coronary calcification is a marker subclinical
  disease and can identify the vulnerable patient.
  The level of calcification directly correlates
  with the level of risk.
• The need for measuring disease activity through
  inflammatory markers or else remains high and
  currently unanswered. CRP does not seem to be the
  one.
• Noninvasive CT imaging has taken the lead in the
  race among diagnostic technologies. Molecular
  imaging holds the future.
• The hot race among emerging intra-coronary
  vulnerable plaque detection technologies slowed.
  IVUS made a come back.
• Aggressive lipid lowering reduces adverse events,
  nonetheless CHD patients experience over 10
  MACE every year.
• Drug eluting stent has become the final contender
  in the fight against restenosis. Its role in
  pre-emptive therapy of non-culprit
  non-flow-limiting plaques remains to be defined.

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From V Plaque to V PatientWhat to expect in the
next 5 years.

• Noninvasive screening of the vulnerable patient
  with CT and IMT will be improved and widely
  practiced.
• Molecular imaging for the detection of vulnerable
  plaques with different target molecules will
  rise, nonetheless, its use for clinical practice
  remains far from 5years.
• Combined LDL-HDL therapy will be the mode of
  treatment. Emerging anti-inflammatory drugs may
  find a role but limited.
• The new coming of IVUS will expand its use in
  cath labs, however, the magnitude of success in
  systemic drug therapy will define the future of
  vulnerable plaque detection.
• Rapid acting systemic drugs for plaque
  stabilization may obviate the need for the
  detection of vulnerable plaques, unless they are
  extremely expensive.
• The outcome of pre-emptive DES clinical trials
  versus the outcome of emerging drug trials will
  define the direction of preventive cardiology to
  2010 and after. The direction may go to more
  non-invasive or may open the floodgate to
  preventive interventional cardiology.

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• In this meeting you will learn how screening
  for the detection and treatment of the vulnerable
  patient presents as a low-hanging fruit of
  preventive cardiology.

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Heart Attack History Makers
Faculty of the Past 9 VP Symposia and the SHAPE
Task Force
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Lets Hope the World Will Do First Thing First!
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SHAPE
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Get in SHAPE!