Related Experiment Videos
Role of preclinical cardiovascular disease in the evolution from risk factor exposure to development of morbid events
1Department of Medicine, Cornell University Medical College, New York, NY.
Insights
Conventional risk factors predict cardiovascular events, but limitations exist. Detecting preclinical cardiovascular disease improves risk prediction, though its clinical utility requires further testing.
Area of Science:
- Cardiovascular Medicine
- Preventive Cardiology
Background:
- Established risk factors like hypertension and high cholesterol predict cardiovascular events but have limitations in risk prediction and reduction.
- Cardiovascular disease progression involves two stages: preclinical disease development and event precipitation, influenced by individual variability.
- Advances in noninvasive diagnostics allow detection of preclinical cardiovascular disease in asymptomatic individuals.
Purpose of the Study:
- To evaluate the role of preclinical cardiovascular disease detection in improving risk stratification.
- To explore the potential of incorporating preclinical disease markers into treatment decisions for hypertension and hyperlipidemia.
Main Methods:
- Review of advances in diagnostic methodology for detecting preclinical cardiovascular disease (e.g., left ventricular hypertrophy, carotid atherosclerosis, renal dysfunction).
- Analysis of the relationship between preclinical disease measures and subsequent risk of complications.
- Discussion of the need for clinical trials to assess the impact of preclinical disease detection on treatment decisions, clinical outcomes, and cost-effectiveness.
Main Results:
- Preclinical cardiovascular disease measures show a closer relation to subsequent risk of complications than traditional risk factors.
- Noninvasive detection of preclinical disease is now feasible in asymptomatic individuals.
- Focusing research on the distinct stages of cardiovascular disease evolution (preclinical development and event precipitation) is a promising strategy.
Conclusions:
- Detection of preclinical cardiovascular disease enhances clinical risk stratification beyond traditional risk factors.
- Further research and clinical trials are essential to validate the widespread adoption of treatment strategies based on preclinical disease detection.
- The clinical utility and cost-effectiveness of integrating preclinical disease markers into treatment decisions remain to be critically evaluated.
Abstract:
Conventional risk factors (especially high arterial pressure, elevated cholesterol and glucose levels, and cigarette smoking) are useful predictors of morbid atherosclerotic and hypertensive events, and their control variably reduces the incidence of events. However, both the ability to predict risk and the ability to reduce it by modification of established risk factors are limited. These limitations occur in part because the progression from risk factor exposure to morbid events depends on the variable likelihood that individuals exposed to the same risk factors will progress through two stages: the development of asymptomatic or "preclinical" anatomic and functional cardiovascular disease in response to standard risk factors and other variables, and the precipitation of morbid events by progression of preclinical disease or by the action of additional "triggering" mechanisms in the presence of preclinical disease. Advances in diagnostic methodology now make possible accurate noninvasive detection in many asymptomatic individuals of preclinical disease such as left ventricular hypertrophy, carotid atherosclerosis, and renal dysfunction. Progress in elucidating stimuli to left ventricular hypertrophy and systemic atherosclerosis suggests that focusing research separately on these two stages of disease evolution is a fruitful strategy. The closer relation of measures of preclinical disease than risk factors with the subsequent risk of complications indicates that their detection improves clinical risk stratification. However, critical testing of whether clinical outcome is improved or treatment cost is lowered by basing antihypertensive or antihyperlipidemic treatment decisions in part on the presence of preclinical cardiovascular disease is needed before this strategy is adopted on a widespread scale.