Atherosclerosis: The XXIst Century Epidemic

See related articles, pages 3336, 3341, 3651, and 3655.> “So oft in theologic wars,> > The disputants, I ween,> > Rail on in utter ignorance> > Of what each other mean,> > And prate about an Elephant> > Not one of them has seen!”> > John Godfrey Saxe's version of the Indian legend, “Blind men and the elephant”Major advances were made in the past decade in the understanding of endothelial injury and the key role of inflammation and atherosclerosis in cardiovascular disease (CVD). A large number of trials for drugs and devices have been successfully completed and it became clear that prevention should be at the core of efforts against CVD. However, every single publication on CVD highlights the “atherosclerosis epidemic” and the continuously increasing burden of vascular events faced by people from all regions in the world. The question is, can anything be done to stop and reverse this devastating trend? To explore possible answers to that question, a meeting was convened at the Pontifical Academy of Sciences in the Vatican.Of the approximately 60 million people who die per year worldwide, 18 million (30%) do so as a consequence of CVD. In other words, 160 000 deaths occur daily of which almost 50 000 are secondary to CVD (equivalent to 100 Boeing 777 aircraft full of people crashing everyday). All of the known risk factors for CVD similarly affect all races and ethnicities.1 More than two thirds of vascular events occur in people with few risk factors and close to 80% affect low-income regions with a higher case-fatality rate compared with the more affluent countries.2 In China and India, CVD will soon overcome communicable diseases (HIV, malaria, tuberculosis) as the Number 1 cause of death. High blood pressure, the most important modifiable risk …