An ounce of prevention is worth a pound of cure...

According to the World Health Organization, about 30% of deaths worldwide result from cardiovascular diseases, many of which may be preventable by modifying or treating risk factors, such as unhealthy diet, smoking, and diabetes. Individuals who have experienced a myocardial infarction or stroke are at significantly high risk of recurrences and death. This risk can be lowered with appropriate pharmacotherapy, such as statins for lowering cholesterol and beta blockers and angiotensin-converting enzyme inhibitors for lowering blood pressure. While secondary prevention with effective pharmacotherapy is extremely successful, the most cost-effective way to reduce risk among an entire population is population-wide intervention. In the United States, often too much focus is placed on optimal management of cardiovascular events after they occur, instead of optimizing strategies to prevent such events. While we should do everything possible to optimally treat our patients, we also need to focus on reducing risk factors by introducing preventive efforts; numerous economic and public health education resources are readily available.

In this issue of Cardiology Review, Dr Kannel describes the use of a general cardiovascular disease risk score as an appealing and cost-effective option to assist office-based primary care physicians in determining preventive treatment in patients at risk for cardiovascular events. Effective use of such a score may help clinicians risk stratify patients appropriately and focus on risk modification and treatment before a major cardiovascular event occurs. In the article by Dr Ghosh and colleagues, the authors report that increasing age, noncardiac comorbidities, and heart failure predicted greater mortality risk after placement of an implantable cardioverter—defibrillator (ICD). Knowledge of these factors may help identify patients who are more likely to benefit from an ICD, saving valuable health care dollars. Subjects who have severe coronary artery disease (CAD) and require percutaneous coronary intervention (PCI) may receive drug-eluting stents. Dr Galløe and associates discuss the safety and effectiveness of these stents in subjects with severe CAD. The authors report a low stent thrombosis rate, which did not significantly increase after discontinuation of clopidogrel therapy 1 year later. Ongoing studies will help determine if more than 1 year of dual antiplatelet therapy will result in improved clinical outcomes in patients undergoing PCI with drug-eluting stents. In the future, we are likely to have more potent adenosine diphosphate receptor antagonists, such as prasugrel, which may also decrease thrombotic event rates after PCI.

I would like to hear your thoughts on using Framingham and other risk scores to determine cardiovascular event risk and whether you use such Web-based scores to risk stratify patients. Letters to the editor can be e-mailed to [email protected].