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VIEWPOINT AND COMMENTARY

Time to Foster a Rational Approach to Preventing Cardiovascular Morbid Events

Rasmussen Center for Cardiovascular Disease Prevention, University of Minnesota Medical School, Minneapolis, Minnesota.

Manuscript received January 25, 2008; revised manuscript received February 21, 2008, accepted February 27, 2008.

^_* Reprint requests and correspondence: Dr. Jay N. Cohn, Cardiovascular Division, Mayo Mail Code 508, University of Minnesota Medical School, 420 Delaware Street SE, Minneapolis, Minnesota 55455. (Email: cohnx001{at}umn.edu).

Efforts to prevent atherosclerotic morbid events have focused primarily on risk factor prevention and intervention. These approaches, based on the statistical association of risk factors with events, have dominated clinical practice in the last generation. Because the cardiovascular abnormalities eventuating in morbid events are detectable in the arteries and heart before the development of symptomatic disease, recent efforts have focused on identifying the presence of these abnormalities as a more sensitive and specific guide to the need for therapy. Advances in noninvasive techniques for studying the vasculature and the left ventricle now provide the opportunity to use early disease rather than risk factors as the tool for clinical decision making. A disease scoring system has been developed using 10 tests of vascular and cardiac function and structure. More extensive data to confirm the sensitivity and specificity of this scoring system and to demonstrate its utility in tracking the response to therapy are needed to justify widespread application in clinical practice.

Key Words: risk factors • noninvasive testing • morbidity

Abbreviations and Acronyms   BP = blood pressure   CVD = cardiovascular disease   LV = left ventricular

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