Early detection of obstructive coronary artery disease
Cardiovascular diseases (CVD) are responsible for approximately 17 million deaths yearly worldwide mainly driven by ischemic heart disease (IHD). Approximately 25% of subjects dying from CVD are due to sudden cardiac death (SCD) in the majority of cases caused by IHD. Unfortunately, in the large majority of patients, SCD and ACS occur suddenly without clear prior complaints and without a previous history of known CAD (previous reported angina, myocardial infarction, CABG or PCI). Most of these patients suffer from concealed IHD and some suffer from another from other chronic degenerative diseases (valvular or heart failure)2-4. The consequences can be disastrous: irreparable damage to the myocardium leading to chronic heart failure, persisting symptoms and restrictions or even be fatal.
The most effective approach to prevent SCD and ACS resides in early diagnosis of IHD followed by early treatment. IHD is clearly age related but one of the major challenges in early IHD diagnosis lies in identifying individuals with vague or presumably no symptoms and diagnostic limitations in primary care, including low sensitive/specific treadmill testing. Symptoms of IHD are known to be more often atypical in women and event typical symptoms are frequently misinterpretation by health care professionals. This underlines the critical role of an adequate screening program to efficiently identify all patients, both men and women, with significant IHD requiring revascularization or medical treatment.
Based on recent and the ongoing improvements in cardiac imaging techniques we believe that we can bring the next large step in reducing SCD and ACS rates by providing an evidence-based diagnostic algorithm to efficiently early diagnose IHD in individuals at high-risk but with vague, misinterpreted or presumably no symptoms at all.
Our objective is to early diagnose at least 25% more patients with IHD requiring guideline based treatment before they suffer an ACS or SCD.
We believe a population based screening approach to diagnose IHD in patients without clear signs and symptoms is the only feasible strategy to bring improvements mandated by the public and the Dutch Heart Foundation. Current improvements in cardiac imaging enable a two stage strategy to first exclude the 90% low risk subjects with CT scan and thereafter early diagnose IHD in the remaining ~10% high-risk group. Biomarkers and online-questionnaires may provide better insights in unrecognized symptoms. As a spin-off new algorithms based on questionnaires and biomarkers may be developed for optimal patient selection.
We believe our strategy will lead to the identification and treatment of IHD and avoids the sudden presentation with ACS or SCD resulting in myocardial damage or death. We aim to translate our findings of the clinical trial to an acceptable population based, national screening program comparable to those existing for several malignancies.