Atherosclerosis discussed on Cardionerds



Progression of underlying atherosclerosis and hartfield. You remember when we place the we are looking at the culprit lesion the lesion that either causing acute coronary event or has a large amount of myocardium at risk. But that one lesion will not be predictive with that patient long-term outcomes if we don't control risk because there are other mild to moderate lesions which can grow and even before becoming symptomatic rupture and cause an acute event and that's probably why some of the failings of interventional large cohorts showing that intensive risk-reduction is just as good as approaching the one culprit. Lesion is not because approaching one corporate. Lesion doesn't help in terms of saving myocardium and relieving symptoms. But because if you don't control the risk the other mild to moderate legions will continue to grow will become unstable rupture so when you look down the road. Two three four years. It's going to be hard to show that you were able to improve survival so i'm not anti coronary intervention by any means but i'm also suggesting that that needs to be done in conjunction with intensive risk reduction the high intensity stat and we need to make sure he got it. We have to educate him of why he has to take it because many patients when they heaven intervention and sometimes the cardiologists the culprit. The patient will feel that they have been quote fixed in probably somewhat lazy fair about risk factor modification. So yeah i would intensively lowered. I would do the high intensity i would suggest. Adding may have some benefit anywhere from ten to fifteen percent would not be surprised if he's going to need a pcsk nine inhibitors. The prior authorization has become a little bit less rigorous at this particular point especially have that relationship with a pharmacy that knows how to access the medications. He may benefit from a pcs nine inhibitor and dietary intervention along with cardiac rehab because cardiac rehab won't allow someone to touch him to measure his blood pressure to make sure he has but drawn to talk to him about his adherents interaction and visualize him while he participates in aerobic activity..

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