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Searching for Vulnerable Subject g j

Best results for the Patient

• Actual Model(symptoms) 43% Survival

Best results for the Patient

( y p )CVD’s Risk Factors, Drugs, CABG, Devices…

• Long Term Model 85% SurvivalgGenetic Panel

Select and monitor

85% SurvivalSignificant impact on

productivity and Costs Population at riskTreat specific Patients

p ysaving.

Treat specific Patients2www.cardiovascularprevention.com

Who is the Vulnerable Subject ?j

He is an High risk person:- Asymptomatic

h i b li i l h l i- having subclinical atherosclerosisnot detectable by common risk factor assessment

He needs aggressive treatment , but he do not know it- Almost all vulnerable individuals have detectable subclinical atherosclerosis- New technology can identify vulnerable individuals with

ffi i t di tisufficient predictive power

www.cardiovascularprevention.com

Cholesterol FailedCholesterol Failed

Quantification of Cholesterol and common Risk Factors failed to predict more than 1/3 of future cardiac death rising from Ischemic heart disease

LDL Goal Cholesterol LDL goals are progressively lowered for CVD prevention, in agree to

Patient 2001* 2004†

High-risk < 100 < 70

NCEP panel IIIModerate-risk < 130 < 100

Low-risk < 160 < 160

4NCEP ATP III = National Cholesterol Education Program Adult Treatment Panel III; LDL = low-density

lipoprotein: Charles H. Hennekens, MD; Medscape General Medicine. 2006;8(1):54. www.cardiovascularprevention.com

Carotid Intima Media Thickness (CIMT)Carotid Intima-Media Thickness (CIMT)

5www.cardiovascularprevention.com

CALCIUM SCORECALCIUM SCOREI th l t l ifi ti t t• In the normal artery calcification are not present.

• The presence of coronary calcification indicates the existence of coronary diseasethe existence of coronary disease.

• The amount of calcification was correlated with the amount of plaque and the number ofthe amount of plaque and the number of coronary stenoses.

• The research of coronary calcium is an excellent ymethod of screening asymptomatic patients.

• The positive predictive power varies from 20 to 35% d ti di ti i l t35% and negative predictive power is close to 100%.


CALCIUM SCORE ASSOCIATED WITH OTHER RISK FACTORS

(From: Raggi e coll. Am. Heart J. March 2001).


SURVIVAL IN RELATION TO CALCIUM SCORE

Survival in 4474 males 3219 females with more than one risk factor in relation to the values of calcium scores measured by EBCT

8

in relation to the values of calcium scores measured by EBCT (Bethesda conference, Jacc 41, 11 2003)


Coronary TC Angiography and Calcium score

9


Coronary TC Angiography 3D rendering

10


Coronary TC AngiographyCoronary TC Angiography

Little calcified plaque(arrows)


Coronary TC Angiography

Proximal LAD

Small calcifiedSmall calcified plaque (arrows)

particular


Coronary TC Angiography

Cx Artery and collateral branch

RA and IVP artery


Right Artery and small septal vessels(arrows)g y p ( )

Coronary TC Angiography Traditional Coronary Angiography


Searching for Vulnerable Subject CV Risk Personal rankingCV Risk Personal ranking

Very High Risk: >20%

High: >2%High :6<20%g

Intermediate : 0.6-5,9 %

L <0 5 %15

Low: <0.5 %www.cardiovascularprevention.com

Noninvasive Screening for Coronary Artery Disease With ComputedNoninvasive Screening for Coronary Artery Disease With Computed Tomography Is Useful

Melvin E. Clouse, MD,


Our Program:Discover the Vulnerable Subject

§ Clinical historyActual MethodOur Method

§ y

§ Common Risk Factors study

Risk Factors evaluation in agreement of F i h d l§ New CVD's Markers

§ C I M T

Framingham model and

NCEP Panel III =§ Calcium Score Index

§ Coronary CT

Insufficient 50%

§ Coronary CT angiography (if indicated)


www CardioVascularPrevention comwww.CardioVascularPrevention.com

23E-mail: [email protected]

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