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Braunwald
1. APPROACH TO IDENTIFYING ANDAPPROACH TO IDENTIFYING AND
MANAGING CORONARY RISKMANAGING CORONARY RISK
Eugene Braunwald, M.D.Eugene Braunwald, M.D.
March 6, 2004March 6, 2004
2. • Prevention of acute events must
be the primary goal. Treatment
should be regarded as “locking the
barn door after the horse is stolen”
3. • One third of cases of sudden death and acute
MI occur in previously asymptomatic persons
- - previously regarded as “acts of God”
• Most of these are now known to have pre-
clinical disease, classical or novel risk factors
• Need to identify high risk asymptomatic
persons prospectively to provide intensive
prevention
4. • All patients with clinically apparent
atherosclerotic disease require
intensive global risk factor reduction
• Some have unstable placques
(“accidents about to happen”) and these
must be identified