RolandoL.deGomaMD

Summary

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  After practicing cardiology for 20 years and seeing how cardiac patients are caught in a revolving door of recurring cardiovascular events, I decided that there must be another way other than more procedures and more stents. In 2001, my personal and professional journey to aggressive CVD prevention began. The L-TAP study uncovered a wide treatment gap nationwide in 2001 - only 18% of CHD patients were treated to LDLc below 100, 82% were either treated inadequately or not treated at all. I developed a hybrid clinical management system to treat most high risk patients to treatment goals and published our performance data in 2006 - 85% were at goal, only 15% were not at goal; there were more patients with LDLc below 50 than over 130. Event rate started to drop after 3 years and this trend still continues even after a decade. Cardiovascular events (heart attack, angina, cardiac hospitalization, procedures, stents, heart bypass, heart failure, etc) used to be common and expected occurrences because of the progressive nature of atherosclerosis, became rare and unexpected. Total CV event reductions attainable in clinical practice far exceed those in clinical trials. Unlike treatment in clinical practice, trials ended after a period of time, as short as 18 months in the JUPITER trial when clinical endpoints were reached. For every $5 spend in the nation, $1 is in healthcare - actually, disease-care. The daily economic burden of largely preventable heart attacks and strokes is $1.2 billion. This is no longer sustainable. The future of CVD management is not more expensive stents but identifying all those at high risk and incorporating aggressive lipid-centered, plaque-directed medical therapy to stop disease progression and when possible, induce disease regression. The Million Hearts Initiative to prevent 1,000,000 heart attacks and strokes in just five years is achievable.