Jeff Sternlicht: Rethinking Cardiovascular Prevention Through Atherosclerosis Imaging
Jeff Sternlicht, Emergency Physician and Medical Director at Vituity, shared a post on LinkedIn:
“Is it time to rethink primary and secondary prevention?
Traditionally, we’ve divided cardiovascular prevention into two categories:
Primary prevention: You haven’t had a cardiovascular event.
Secondary prevention: You have.
But here’s the problem.
What about the patient who has never had a heart attack, yet has substantial coronary atherosclerosis on imaging?
Technically, they’re still in the primary prevention category. Biologically, they already have the disease whose progression and complications we’re trying to prevent.
With coronary calcium scoring and coronary CT angiography, we can increasingly identify atherosclerosis before the first clinical event.
Perhaps we should be thinking beyond primary versus secondary prevention and asking:
Does the patient have atherosclerosis? And if so, how much?
Of course, imaging isn’t appropriate for everyone, and traditional risk factors remain essential. But when we have evidence of actual disease, shouldn’t that inform how aggressively we intervene?
I was inspired by an excellent National Lipid Association Lipid Insights podcast conversation featuring Alan Brown and Nihar Desai.
This is also central to my upcoming presentation, Practical Lipid Management in the Era of Coronary CT, at the Southwest Florida Cardiovascular Imaging Symposium next month.
We’re moving toward an era where cardiovascular prevention can be guided not just by estimated risk, but by the presence and burden of atherosclerosis itself.
Curious how others are incorporating imaging detected atherosclerosis into preventive care.”
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