Diagnosis and treatment of non-hemodynamically significant coronary heart disease: where to start?

In the U.S. and all industrialized countries, more deaths result from heart attack and stroke than from any other cause. Increasingly it is proposed that many cardiac events occur following the rupture of minor, non-hemodynamically significant atherosclerotic plaque. Indeed many policy makers and some physicians have questioned the importance of traditional screening and treatment strategies for hemodynamically significant coronary artery lesions. As an alternative, it has been suggested that screening and treatment approaches should be guided by emerging data that support the predictive value of measures of inflammation, such as high sensitivity C-reactive protein, or of genetic markers. Our goal is review the biology of acute coronary events and the results of population-based studies and, in this light, consider the usefulness of the current "state-of-the-art" methods for diagnosing coronary heart disease.