Next Steps in Primary Prevention of Coronary Heart Disease: Rationale for and Design of the ECAD Trial

Michael J Domanski; Valentin Fuster; Francisco Diaz-Mitoma; Scott Grundy; Donald Lloyd-Jones; Muhammad Mamdani; Robin Roberts; Kevin Thorpe; Judith Hall; Jacob A Udell; Michael E Farkouh

doi:10.1016/j.jacc.2015.08.857

Next Steps in Primary Prevention of Coronary Heart Disease: Rationale for and Design of the ECAD Trial

J Am Coll Cardiol. 2015 Oct 20;66(16):1828-1836. doi: 10.1016/j.jacc.2015.08.857.

Authors

Affiliations

¹ Icahn School of Medicine at Mount Sinai, New York, New York; Heart and Stroke/Richard Lewar Centre of Excellence, University of Toronto, Toronto, Ontario, Canada; Peter Munk Cardiac Centre, University of Toronto, Toronto, Ontario, Canada. Electronic address: [email protected].
² Icahn School of Medicine at Mount Sinai, New York, New York; Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain.
³ Advanced Medical Research Institute of Canada, Sudbury, Ontario, Canada.
⁴ University of Texas, Southwestern University Medical School at Dallas, Dallas, Texas.
⁵ Northwestern University Medical School, Chicago, Illinois.
⁶ Applied Health Research Centre, Li Ka Shing Knowledge Institute, University of Toronto, Ontario, Canada.
⁷ McMaster University, Hamilton, Ontario, Canada.
⁸ Heart and Stroke/Richard Lewar Centre of Excellence, University of Toronto, Toronto, Ontario, Canada; Peter Munk Cardiac Centre, University of Toronto, Toronto, Ontario, Canada; Women's College, Peter Munk Centre, Research Institute and Cardiovascular Division, Department of Medicine, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada.
⁹ Icahn School of Medicine at Mount Sinai, New York, New York; Heart and Stroke/Richard Lewar Centre of Excellence, University of Toronto, Toronto, Ontario, Canada; Peter Munk Cardiac Centre, University of Toronto, Toronto, Ontario, Canada.

PMID: 26483108
DOI: 10.1016/j.jacc.2015.08.857

Abstract

Atherosclerotic cardiovascular disease (ASCVD) events, including coronary heart disease and stroke, are the most frequent cause of death and major disability in the world. Current American College of Cardiology/American Heart Association primary prevention guidelines are mainly on the basis of randomized controlled trials of statin-based low-density lipoprotein cholesterol (LDL-C)-lowering therapy for primary prevention of ASCVD events. Despite the clear demonstration of statin-based LDL-C lowering, substantial 10-year and lifetime risks of incident ASCVD continue. Although the 10-year risk is low in young and middle-aged adults who would not be treated according to current guidelines, they ultimately account for most incident ASCVD. If statin-based LDL-C lowering were initiated in them at an age before complex coronary plaques are common in the population, a substantial reduction in lifetime risk of incident coronary heart disease might be achieved. We examine this hypothesis and introduce the design of a currently recruiting trial to address it. (Eliminate Coronary Artery Disease [ECAD]; NCT02245087).

Keywords: atherosclerosis; atherosclerotic; cholesterol; hydroxymethylglutaryl-CoA reductase inhibitors; plaque; primary prevention.

Publication types

Review

MeSH terms

Adult
Asymptomatic Diseases
Cholesterol, LDL / blood
Cholesterol, LDL / drug effects*
Coronary Disease / blood
Coronary Disease / epidemiology
Coronary Disease / prevention & control*
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors / administration & dosage
Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use*
Patient Selection
Plaque, Atherosclerotic / prevention & control*
Primary Prevention / methods*
Randomized Controlled Trials as Topic*
Research Design
Risk Assessment
Risk Factors

Substances

Cholesterol, LDL
Hydroxymethylglutaryl-CoA Reductase Inhibitors

Associated data

ClinicalTrials.gov/NCT02245087