Heart Disease (cont’d)
Management of Stable Coronary Artery Disease (“RCT”)
Maron et al, NEJM 2020
PCI Utilization Trends in the US
Almarzooq et al, JAMA Cardiology 2021
Primary vs Secondary Prevention of Heart Disease
Blaha, Am J Cardiol 2016
Primary Prevention of Cardiovascular Disease with Statins*
Mortenson et al, JAMA Cardiology 2019
*: NNT – Number needed to treat
Statin mechanisms:
•Inhibition of rate-limiting enzyme in
cholesterol synthesis
•Anti-inflammatory effects
•Reduction of smooth muscle cell
proliferation/migration
•Attenuation of platelet activation
and other elements of “pro–
coagulation”
Cardiac Risk Factor Assessment
https://tools.acc.org/ascvd-risk-estimator-plus/#!/calculate/estimate/
Coronary Artery Calcification
Vergallao and Crea, NEJM 2020
•Pathway of plaque instability (rupture) vs
healing is influenced by several factors
• Instability: “pro–inflammatory” state in which
collagen/matrix formation is reduced
• Healing: “anti–inflammatory” state in which both
collagen/matrix formation and calcium
