Questions for The Discussion Panel

Towards Implementing the VP Pyramid
 
     
     
Q1 Despite the widespread public knowledge of coronary risk factors, the incidence of heart attacks is escalating, what seems to be going wrong?  
     
Q2 Having about 140 million 35y or older at the base of the VP Pyramid and 1.4 million heart attacks on the top, a scale of 1% screening is required. How many steps of screening do you provision and what is the most important step?  
     
Q3 Approximately 50% of the 1.4 million are people without any prior diagnosis of cardiovascular disease or risk factors, how can we reach them?  
Q4 Is Framingham risk prediction model sufficient for predicting near term coronary events? Should CRP be added to Framingham Risk Score? How about Coronary Calcium Score?  
     
Q5 If all US population older than 35y (140 millions) assess their Framingham score, what percentage of them will be ranked in low, intermediate, and high risk group respectively? Should physicians request routine coronary calcium imaging for people ranked a high percentile in Framingham Score?  
     
Q6 Would you order a non-invasive coronary angiography or a perfusion imaging test for those who ranked top 25% in their age and sex adjusted coronary calcium score?  
     
Q7 Which one do you prefer, non-invasive CT angiography or non-invasive MR angiography? Does MRI have any future in coronary assessment or it should be limited to aorta and carotids?  
     
Q8 Should the pathway of “stress ECG >> nuclear imaging >> cath lab” be reevaluated?  
     
Q9 Will you agree to stent a rupture-prone vulnerable plaque (e.g. a thin cap fibroatheromo)? What if it is associated  with either high strain in palopography or high temperature in thermography?  
     
Q10 Do you agree that screening and intervention for vulnerable patients can be cost-effective?