Lancet study calls for major shift in treatment of heart disease
Coronary artery disease (CAD) continues to be a leading cause of morbidity and mortality globally.
The recommendations that focus on preventing blockages in arteries that develop due to accumulation of fat, cholesterol etc are in line with a recent school of thought that moves the focus to early diagnosis, prevention, and management for most diseases, with the ultimate objective being to save more lives and reduce the massive financial cost involved in treating end-stage diseases.
The recommendations say the current approach, “which focuses on diagnosing and managing coronary artery disease based on ischaemia (restricted blood flow to the heart) and cardiovascular events, is flawed”. “By the time ischaemia manifests, it is often too late for optimal intervention, limiting the effectiveness of treatment options… The focus of medical care has predominantly been on the recognition of symptoms and treatment of acute events, missing opportunities for early detection and prevention of disease…,” it adds.
Instead, the Commission suggests “reclassifying the condition as atherosclerotic coronary artery disease (ACAD), moving away from the traditional emphasis on ischaemia and acute cardiac events towards a more systematic understanding of atherosclerosis”. It adds that the new approach could potentially save “ millions of lives worldwide.”
“The Lancet Commission’s rethinking of prioritizing preventive aspects of atherosclerotic coronary artery disease (ACAD) from focusing on the detection and prompt management of the end stage of atherosclerosis leading to heart attacks and sudden death to basics of preventing the building up of the plaque in the arteries, makes lot of sense,” said Upendra Kaul, chairman cardiology and dean academics and research, Batra Hospital and Medical Research Centre. “The emphasis needs to shift from spending colossal amounts on diagnosing the end product of advanced ACAD and managing it to prevent the development of atheroma which is the root cause of advanced atherosclerosis.”
“Targeted screening programmes, integrated into healthcare systems, can detect early signs of atherosclerosis and enable timely intervention. Such interventions, if applied early, have the potential to halt, delay, or even reverse the progress of the disease, reducing the risk of cardiovascular events in later life,” it said.
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