Asymptomatic Atherosclerosis Pathophysiology, Detection and Treatment

Despite recent advances in the diagnosis and treatment of symptomatic atherosclerosis, available traditional screening methods for early detection and treatment of asymptomatic coronary artery disease are grossly insufficient and fail to identify the majority of victims prior to the onset of a life-threatening event. In Asymptomatic Atherosclerosis: Pathophysiology, Detection and Treatment, Dr. Morteza Naghavi and leading authorities from the Society for Heart Attack Prevention and Eradication (SHAPE) present a new paradigm for the screening and primary prevention of asymptomatic atherosclerosis. The text focuses on accurate, yet underutilized, measures of subclinical atherosclerosis, notably coronary artery calcium scanning and carotid intima-media thickness measurement. The authors introduce a comprehensive approach to identifying the vulnerable patients (asymptomatic individuals at risk of a near future adverse event). Additional chapters discuss future directions towards containing the epidemic of atherosclerotic cardiovascular disease using innovative solutions such as preemptive interventional therapies (bioabsorbable stents) for stabilization of vulnerable atherosclerotic plaques, mass unconditional Polypill therapy for population-based risk reduction, and ultimately vaccination strategies to prevent the development of atherosclerosis. Up-to-date and authoritative, Asymptomatic Atherosclerosis: Pathophysiology, Detection, and Treatment is a must-have for any cardiologist or primary care physician who wishes to practice modern preventive cardiology and manage the increasing number of asymptomatic atherosclerotic patients. Outlines more accurate measures of risk (coronary artery calcium and carotid intima-media thickness) than traditional risk factors (total cholesterol, LDL cholesterol, HDL cholesterol) Presents new multipronged strategies to aid in the early detection and treatment of high risk asymptomatic patients

1. Preventive Cardiology: The SHAPE of the Future.- 2. From Vulnerable Plaque to Vulnerable Patient.- 3. Pathology of Vulnerability Caused by High Risk (Vulnerable) Arteries and Plaques.- 4. Pathophysiology of Vulnerability Caused by Thrombogenic (Vulnerable) Blood.- 5. Vulnerability Caused by Arrhythmogenic Vulnerable Myocardium.- 6. Approach to the Identification of the Vulnerable Patient.- Current Screening Guidelines in Primary Prevention.- Burden of Atherosclerotic Cardiovascular Disease. Risk Factors vs Susceptibility vs Vulnerability. Screening for Silent Disease to Prevent Deadly Disease. Screening for Atherosclerosis vs Screening for Risk Factors of Atherosclerosis. Methods for the Detection of Subclinical Atherosclerotic Cardiovascular Disease.- Risk Factors: 7. History of evolution of cardiovascular risk factors and the predictive value of
Traditional Risk Factor-Based Risk Assessment.-  8. Comprehensive Lipid Profiling Beyond LDL.- 9. New Serum Markers of Inflammation and Atherosclerosis.- 10. Genetic Screening and Sudden Cardiac Death.- 11. Genomics and Proteomics: The Role of Contemporary Biomolecular Analysis.- In Advancing the Knowledge of Atherosclerotic Coronary Artery Disease.- 12. Circulating Endothelial Progenitor Cells – Mechanism and Measurements.- 13. Family History: An index of genetic and environmental predisposition to coronary artery disease.- 14. Integration of Markers of Endothelial Activation in Mechanism-based Management of Coronary Artery Disease.- Non Invasive, Non Imaging, Assessment of Atherosclerotic Cardiovascular Disease (ACVD)

15. Exercise stress testing in asymptomatic individuals and its relation to
subclinical atherosclerotic cardiovascular disease

16. The Ankle Brachial Index

17. Arterial Elasticity/Stiffness

18. Assessment of Endothelial Function in Clinical Practice

19. Digital (Fingertip) Thermal Monitoring of Vascular Function: A Novel Non-

invasive Non-imaging Test to Improve Traditional Cardiovascular Risk

Assessment and Monitoring of Response to Treatments

20. Assessment of Macro & Micro Vascular Function and Reactivity

Non Invasive Structural Imaging of Subclinical ACVD

21. Computed Tomographic Angiography

22. Carotid Intima-Media Thickness

23. Carotid intima-media thickness: clinical implementation in individual

cardiovascular risk assessment

24. Non-Invasive Coronary CT Angiography

25. Non-Invasive CT v.s. MRI for Characterization of Atherosclerosis Plaque

26. Non-Invasive Magnetic Resonance Imaging of Aorta and Coronary Arteries

27. The Role of MRI in Examining Subclinical Carotid Plaque

Non Invasive Functional Imaging of Subclinical ACVD

28. Ultrasound Imaging of Brachial Artery Reactivity (FMD)

29. Silent and Stress-Induced Myocardial Ischemia

30. Targeted MRI of Molecular Components in Atherosclerotic Plaque

31. Non Invasive imaging of vulnerable myocardium- MRI and CT based

Invasive Assessment of ACVD

32. Angiographic Detection of Complex and Vulnerable Atherosclerotic Plaques

33. Intravascular Methods for Characterizing Potentially High Risk Coronary

Plaques.
34. Detecting Vulnerable Plaque Using Invasive Methods

35. Assessment of Plaque Burden and Composition using Intravascular
Ultrasound

36. Vasa Vasorum Imaging: A New Window to the Detection of Vulnerable
Atherosclerotic Plaques

37. The First SHAPE Guideline;

38. Cost-Effectiveness of Screening for Atherosclerosis vs. Screening for Risk
Factors of Atherosclerosis

39. Monitoring of Subclinical Atherosclerotic Disease

40. Implications of SHAPE Guideline for Improving Patient Compliance

41. The Cost-Conscious SHAPE Guideline – Why Primary Care Physicians
Should Embrace It

42. Should we treat based on SHAPE guidelines??

43. Duty-Bound: Philosophical Foundations of Clinical Strategies for Prevention
of Cardiovascular Events

44. Dynamic Changes in Risk as the Basis for Therapeutic Triage

Treatment of Subclinical ACVD and Vulnerable Patients

Systemic Therapies

45. LDL Targeted Therapies

46. Antioxidants as targeted therapy: a special protective role for pomegranate
and paraoxonases (PONs)

47. Multi-Constituent Cardiovascular Pills (MCCP) – Challenges and Promises of Population Based Prophylactic Drug Therapy for Prevention of Heart Attack

48. Vaccine for Atherosclerosis: An Emerging New Paradigm

Focal Therapies for Vulnerable Arteries and Plaques

49. Drug Eluting Stents: A Potential Preemptive Treatment Choice for
Vulnerable Coronary Plaques

50. Intrapericardial Approach for Pan Coronary Stabilization of the Vulnerable
Arteries and Myocardium

Educations, Life Style Modifications and Non-pharmacologic Therapies for the
Atherosclerosis Susceptible and ACVD Vulnerable Population

51. Dietary Management for Coronary Atherosclerosis Prevention &
Treatment

52. Management of Preconditioning Physical Activity in a Vulnerable Patient; Getting in SHAPE

53. Acute Prevention of the Heart Attack: the Identification of Prodromal
Symptom Recognition as the "Rosetta Stone" in Solving the Heart Attack
Problem