This document discusses vulnerable plaque and strategies for its early detection and prevention of cardiac events like heart attack and sudden death. It notes that vulnerable plaque, not blockages, are the major underlying cause of acute coronary events. Early detection of vulnerable plaque could prevent over 1.5 million heart attacks and 500,000 sudden deaths annually. It proposes expanding screening through home-based and non-invasive tests to identify more high-risk "vulnerable patients" and ultimately develop treatments to eradicate heart attacks by detecting and treating vulnerable plaque.

1. How the World Dies Today?

3. W.H.O

5. Everybody has atherosclerosis, the question is who has vulnerable plaque
Sudden Cardiac Death
Acute MI
Vulnerable
Plaque(s)

6. Compensatory Enlargement
of Human Atherosclerotic Coronary
Arteries
N Engl J Med 1987 May
28;316(22):1371-5
<50%
stenosis
Luminal area is not endangered until more than 40% of
internal elastic lamina is destructed and occupied by plaque
Coronary artery disease is a disease of arterial wall
disease not lumen.
PositiveRemodeling
<80%
stenosis

8. PlaqueEruption (Volcano!)

14. Different Types of Vulnerable Plaques
Major Underlying Cause of Acute Coronary Events
Normal
Rupture-prone
Fissured Eroded
Critical Stenosis Hemorrhage
Naghavi et al, Cur Ath Rep 2001

16. How important is
early detection of
vulnerable plaque?

17. In 70% of cases the
first symptom of
having a vulnerable
plaque is sudden
death outside of
hospital.

18. 1.5 million heart attacks, 6
million heart failures and
500,000 sudden deaths
can be prevented
if
vulnerable plaque is
detected and treated.

19. In search of
“vulnerable patient”

20. 1,400,000 Annual Heart Attacks
140,000,000 Americans>35y
Home-Based
Screening
Non-invasive
Imaging
Office-Based
Screening
Invasive Dx
with Rx2-3 millions
40-50 millions
50-60 millions
Non-invasive
Home-Based
Biomarkers(Glu,
Chol, CRP, …)
Self-Screening
Questionnaire
CT Calcium and
Cholesterol Imaging
NoninvasiveAngiography
Non-InvasiveMolecular Imaging
for Plaqueand Myocardium
Characterization
Homeand Office
Based Endothelial F.
Test, ECG…
Intravascular Ultrasound, Thermography,
OCT, NIR Spectroscopy…
Home-Based, Non-Invasive,
Easy and Inexpensive
Non-Invasive Imaging

21. 2001 2050
Genomic
Proteomic
2007 2015 2020 2040
VP Treatment
Home-based VP
Screening Test
Heart Attack
Rate Falls
Below 10,000
per year
Cloning Heart
VP Rx as OTC
and
Vaccine against
heart attack
Eradication of Heart Attack
VP Detection
Mission:

22. Association for Eradication of Heart Attack
www.VP.org