Q1. Statistics indicate that over 50% of first-time heart attack victims die suddenly before reaching hospital, and this has been the case since 1960s? Does this mean that the field of cardiovascular medicine is fundamentally handicapped in reaching 50% of its target population? How can we break this statistics?
Q2. Autopsy series and recent IVUS studies indicate that more than 50% of adults have some degree of atherosclerotic plaque, therefore the question is who has vulnerable plaque. Do you agree that we should focus on screening for vulnerable plaque instead of atherosclerosis? Do you think that risk factors of vulnerable plaque might be different from risk factors of atherosclerosis?
Q.3- We know that a significant number of patients with coronary artery disease do not have any of the traditional risk factors, and on the other hand some people with high cholesterol and other risk factors live long (80s y) but never experience heart attack? What does it mean to you? Do we know enough? Should we look for protective factors?
Q.4- Do you agree that besides vulnerable plaque we should pay attention to vulnerable (trombogenic) blood and also vulnerable (electrically unstable) myocardium? In other words should we go beyond plaque and focus on vulnerable patient?
Q.7- Do you think that plaques diagnosed either by thermography (hot plaque) or elastography (soft plaque) etc. (e.g. upper quintile in each) should be stented by drug-eluding stent even if they are not stenotic (<50%)? Will you be completely satisfied if the rate of restenosis is less than 10% or will you be looking for a pan-arterial treatment instead of multiple stenting?
Q.8- Do you anticipate a serum screening test like PSA to identify the risk of near-future heart attack? How about a home-based kit for genetic profiling and screening of vulnerable patients? Are these realistic wishes or only fantasies?!