We essentially live in our blood vessels and age in our arteries.CAD is the principal cardio vascular disease, which God has created in Homo-sapiens to ensure they do not stay more than “allotted life span” in this planet. Of course , the current generation cardiologists equipped with scientific weapons , have since decided to take the fight directly in the Almighty’s domain .Contrary to the popular medical doctrine, treating an established CAD seems to be easier task than preventing a new onset CAD.
While , arteriosclerosis is a normal aging process, atherosclerosis could be an aging as well as a distinctive pathological process. However , athero-thrombosis is a definite pathology of vessel wall .We know at any time atherosclerosis can transform into athero-thrombosis and result in clinical event depending upon the triggers and other associated conditions, which we refer to as major or minor risk factors.
In scientific terms ,
- Primary prevention of CAD is preventing first episode of Coronary event*(Typically , CSA, STEMI/UA,NSTEMI/SCD,)
- Secondary prevention is prevention of second or subsequent episodes following the first clinical event.(*What if , if the first event is silent and never known ? )
For all practical purposes CAD and coronary atherosclerosis is synonymous. Can we prevent atherosclerosis in human biological system ? What are we supposed to refer to such a preventive measure , if any ?
We are biased towards obstructive CAD as we often think it is the the only form of CAD .Then , how do we diagnose , treat and prevent a minimal non flow limiting plaque , coronary endothelial dysfunction , or acute coronary erosion that can occur in very early stages of atherosclerosis, in other wise healthy persons.(Routine IVUS ,OCT ? Futile isn’t )
- Preventing sub-clinical CAD from manifesting as clinical CAD , is technically primary prevention” but still patho-biologically secondary prevention.
- Preventing a CAD in a patient with peripheral vascular disease or preventing CAD in a patient with TIA or stroke is secondary prevention for cerebrovascular disease but falls within the definition of primary prevention of CAD.
- Then comes the new semantics :Primordial prevention .This could be same as primary (or another version of primary prevention ).Primordial prevention is preventing development the risk factor itself (Like DM,HT, Dyslipidemia )
So ,whenever , we talk about primary prevention of CAD by Aspirin or Statins ,realize the complexities involved .Before i finish, let me make you dizzy further with this quixotic one . In a multivessel CAD, as the atherosclerotic plaques are scattered across the coronary arteries in various stages of maturity , long term Aspirin following anterior STEMI has to secondary prevent an event in LAD territory . . . but primary prevent a plaque disruption in RCA territory !
Reference
1.USPSTF Guidelines : Aspirin for the Prevention of Cardiovascular Disease: Preventive Medication
Dr.S.Venkatesan MD 