Surrogate atherosclerotic markers and atherosclerosis risk assessments.

Atherosclerotic disease (stroke, acute coronary syndrome, chronic coronary artery disease, and peripheral artery disease) is the most important health problem facing the developed world. Recent advances in vascular biology have provided a better understanding of the roles of cellular adhesion and transendothelial infiltration, oxidation of low-density lipoprotein–cholesterol, macrophage and foam cell transformation, plaque rupture, platelet aggregation, and the cascade of coagulation in pathogenesis and clinical manifestation of atherothrombotic disease. Evidence-based treatments have naturally targeted thrombolytic, anticoagulant, and antiplatelet therapies. Subsequently, intensive secondary preventive measures have focused on more aggressive control of the predisposing risk factors (smoking, dyslipidaemia, hypertension, obesity, diabetes mellitus, and hyperfibrinogenaemia). Evidence for treatment benefit in primary prevention has been less than overwhelming, and the application of such strategies is questionable on cost-effectiveness grounds, particularly in light of the constraints on public health resources.