Modern prevention: genetic testing, vascular imaging, machine learning, and drug safety

Traditionally, prevention has been divided into primary and secondary prevention. While the former focused on individuals considered healthy, the latter was designed to avoid future events in those who already had coronary artery disease, myocardial infarction, or stroke.1 However, this distinction is no longer useful, as many asymptomatic individuals do have atherosclerotic lesions such as plaques and calcifications upon modern imaging, and not all subjects with suspected symptoms have atherosclerotic vascular disease.2 –4 This Focus Issue on Prevention addresses these important issues. In a firstCurrent Opinion entitled ‘Assessing suspected angina: requiem for coronarycomputed tomographyangiography or exerciseelectrocardiogram?’, Christian J.M. Vrints and colleagues from the University Hospital Antwerp in Edegem, Belgium discuss the 2013 ESC Guidelines on stable coronary artery disease considering recently published randomized trials. PROMISE5 and SCOT-HEART6 examined whether a strategy of initial anatomical testing with the use of coronary computed tomographic angiography instead of conventional functional testing could lead to improved outcome in patients with suspected stable angina pectoris, with somewhat differing results.7 The authors address what the neutral results of PROMISE and the more positive results of SCOT-HEART mean for the practising cardiologist. Based on the entire evidence, they conclude that currently there is no convincing evidence from prospecti...
Source: European Heart Journal - Category: Cardiology Source Type: research