ATHEROSCLEROSIS: EARLY DIAGNOSIS IS THE MISSING ELEMENT

Resumen

As we anticipate modification of the current guidelines for managing risk factors, one might contemplate our current approaches to arteriosclerosis. The major resources devoted to this disease are still spent after the clinical presentation of severely affected patients. Expensive techniques to diagnose and treat specific lesions in the coronary, peripheral and cerebral arteries consume a huge outlay of funds in industrially developed countries. As affluence grows in developing countries, we are seeing the same approach. Evaluating chest pain with relatively insensitive techniques such as resting electrocardiograms, exercise tests and radio-nucleotide scans often leads to angiography or expensive multi-slice computed tomography. Even when lesions are demonstrated, the direct link to the clinical symptoms is not made with certainty. Only during an acute event does the direct attack on a lesion seem to make a difference. We now have excellent studies in stable patients demonstrating little additional benefit from procedures such as angioplasty and coronary by-pass surgery when systemic treatment of arteriosclerosis by risk factor reduction is used instead. This treatment using aggressive life style change and drugs that produce lipid lowering and blood pressure control are still needed after such procedures. Why are we spending our precious resources on poorly documented and expensive therapies that seem justified by practice patterns rather than logical interpretation of scientific evidence?.