Multimodality imaging in prevention of coronary artery disease: creating synergy between tests and therapies

In the Netherlands, 34.000 individuals suffer from a heart attack and 36.000 individuals die from cardiovascular disease yearly. A heart attack is caused by calcification of the coronary arteries of the heart, also known as coronary artery calcification. Currently, no national screenings program exists for coronary artery calcification, unlike for other common diseases such as cancer. Prevention of coronary artery calcification, that can cause heart attack or sudden cardiac death, is currently arranged in a way that individuals need to visit the general practitioner themselves in the Netherlands to seek preventive care. The general practitioner will then make a risk estimation based on the presence of traditional risk factors for coronary artery calcification, such as high blood pressure and smoking. Based on this risk estimation, early therapy with support in lifestyle adjustments, such as quitting smoking, and in certain cases also prescription of cholesterol- and blood pressure-lowering medication is initiated. Risk estimation based on clinical risk prediction doesn’t provide a direct image of what is happening in the coronary arteries. This risk prediction is therefore often inaccurate, leading to over- and undertreatment. By a combination of imaging techniques of the heart, such as CT- and MRI-scans, coronary artery calcification can be early detected, which allows for treatment adapted to the actual state of disease. The use of imaging techniques of the heart to predict the risk of heart attack and sudden cardiac death in screening, in which each individual who would like to can undergo a scan, might allow a unique chance to early detect and effectively treat individuals with a strongly increased risk, before they suffer from severe damage to the heart. In this thesis, a first step is being made by investigating whether several stages of subclinical coronary artery calcification can be effectively detected by a combination of imaging techniques of the heart, and whether this leads to improved prevention. Also, this thesis tries to seek for methods to improve the selection of those who potentially benefit from early detection, to reduce costs and increase efficiency.