Next Steps in Primary Prevention of Coronary Heart Disease: Rationale for and Design of the ECAD Trial

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• 作者：Michael J. Domanski ; MD^&lowast ; ; ^&dagger ; ; ^&Dagger ; ; ^{michael.domanski@uhn.ca" class="auth_mail" title="E-mail the corresponding author} ; Valentin Fuster ; MD ; PhD^&lowast ; ; ^§ ; ; Francisco Diaz-Mitoma ; MD ; PhD^鈥?/sup> ; Scott Grundy ; MD ; PhD^¶ ; ; Donald Lloyd-Jones ; MD^# ; Muhammad Mamdani ; PharmD ; MPH^&lowast ; &lowast ; ; Robin Roberts ; MSc^&dagger ; &dagger ; ; Kevin Thorpe ; MSc^&lowast ; &lowast ; ; Judith Hall ; PhD^&lowast ; &lowast ; ; Jacob A. Udell ; MD^&dagger ; ; ^&Dagger ; ; ^&Dagger ; &Dagger ; ; Michael E. Farkouh ; MD ; MSc^&lowast ; ; ^&dagger ; ; ^&Dagger ;
• 关键词：atherosclerosis ; atherosclerotic ; cholesterol ; hydroxymethylglutaryl-CoA reductase inhibitors ; plaque ; primary prevention
• 刊名：Journal of the American College of Cardiology
• 出版年：2015
• 出版时间：20 October 2015
• 年：2015
• 卷：66
• 期：16
• 页码：1828-1836
• 全文大小：505 K

文摘

Atherosclerotic cardiovascular disease (ASCVD) events, including coronary heart disease and stroke, are the most frequent cause of death and major disability in the world. Current American College of Cardiology/American Heart Association primary prevention guidelines are mainly on the basis of randomized controlled trials of statin-based low-density lipoprotein cholesterol (LDL-C)–lowering therapy for primary prevention of ASCVD events. Despite the clear demonstration of statin-based LDL-C lowering, substantial 10-year and lifetime risks of incident ASCVD continue. Although the 10-year risk is low in young and middle-aged adults who would not be treated according to current guidelines, they ultimately account for most incident ASCVD. If statin-based LDL-C lowering were initiated in them at an age before complex coronary plaques are common in the population, a substantial reduction in lifetime risk of incident coronary heart disease might be achieved. We examine this hypothesis and introduce the design of a currently recruiting trial to address it. (Eliminate Coronary Artery Disease [ECAD]; NCT02245087)