TITLE:
The Basis of Atherosclerotic Guidelines—Time for a Change?
AUTHORS:
David S. Schade, R. Philip Eaton
KEYWORDS:
Randomized Controlled Trials, Pathophysiology, Clinical Practice Guidelines, Internal Validity, External Validity, Target-Based Therapy
JOURNAL NAME:
World Journal of Cardiovascular Diseases,
Vol.8 No.7,
July
25,
2018
ABSTRACT: Major advances have occurred within the last decade in the understanding of the pathogenesis of coronary artery disease. Not only are the underlying mechanisms now clearly defined, but effective medical therapies are available at low cost and minimal side effects. In spite of these advances, cardiovascular events are still the leading cause of death in the United States and the Western world. Analysis of the many factors involved in the delivery of appropriate cardiovascular care strongly suggests that the primary reason is the overly restrictive guidelines published by medical societies. This article proposes a much broader basis for constructing atherosclerosis clinical guidelines, namely the known pathophysiology of atherosclerosis. If pathophysiology forms the basis of atherosclerotic treatment recommendations, then a risk/benefit analysis can be used to determine appropriate preventive therapy for any specific individual. The result will be that many additional individuals will be eligible for preventive treatment of atherosclerosis, and the saving of many lives at minimal cost will result.