There is a movement to reframe the definition and treatment of coronary artery disease (CAD). What has been misunderstood about coronary artery disease?
There has been a lot of effort directed towards the detection and treatment of coronary artery disease (CAD) which relates to the slow build of atherosclerosis, the buildup of plaque in the small arteries of the heart. Clinical trials have found that treating a key feature of CAD, ischemia, alone does not improve mortality or reduce the risk of future cardiac events. But it may play a small role in treating symptoms like chest pain. Yet, the most important factor in preventing cardiovascular death and disease is preventing the development of atherosclerosis and unstable plaques that lead to premature death.
The Lancet Commission proposes renaming CAD to atherosclerotic coronary artery disease (ACAD). What is the significance of this terminology shift?
The emphasis on atherosclerotic coronary artery disease (ACAD) reframes the diagnosis for CAD. The current definition used for diagnostic and coding purposes requires obstructive or ischemia conditions to meet criteria. However, this leads to a blind eye to the early disease course. The future of cardiovascular prevention should develop effective strategies that focus medical resources on the earlier treatment and diagnosis of CAD. We need more research to advance care before stable ischemia develops, and this new framework can identify atherosclerotic coronary disease earlier.
What are the key strategies for preventing CAD early in life?
Cardiovascular disease remains largely preventable due to lifestyle modifications and control of critical risk factors that increase the risk for adverse cardiovascular events and disease. Key strategies include:
- Maintaining health blood pressure and treating hypertension early
- Identifying and treating dyslipidemia when currently indicated
- Avoiding toxic habits related to tobacco and drug use
- Preventing and treating obesity, as it is the primary risk factor that contributes to both hypertension and dyslipidemias
- Healthy lifestyle habits around nutrition and exercise prevent cardiovascular risk factors from developing and cardiovascular diseases
What role do healthcare providers and policymakers play in implementing this new approach?
As healthcare providers, we can adopt a proactive mindset, integrating risk assessments and prevention strategies into routine care that align with our patients’ goals of living a long life free of cardiovascular disease. We already have a lot knowledge and treatment strategies to reduce the risk of developing cardiovascular disease, which remains the leading cause of death worldwide. But we need to prioritize identifying preventative strategies earlier in adulthood to reduce death rates from cardiovascular disease. Policymakers also have a crucial role in promoting public health initiatives, supporting research on early prevention, and ensuring access to affordable preventive care and medications.
What impact could this shift in focus have on global heart disease rates?
If we can control the main risk factors for cardiovascular disease, we can save millions of lives. As the recent Lancet Report highlights, “if all behavioural and metabolic risk factors were controlled and eliminated, 82.1% of atherosclerotic heart disease deaths could be prevented and 8.7 million lives could be saved by 2050.”
By identifying and treating atherosclerosis early, we can reduce the incidence of heart attacks and the need for invasive procedures. This shift has the potential to save millions of lives worldwide, decrease healthcare costs, and improve overall quality of life. Our goal should be to create a paradigm where heart disease prevention starts early, leading to healthier aging and a reduced burden of cardiovascular disease globally.
