Next steps in primary prevention of coronary heart disease rationale for and design of the ECAD Trial

Michael J. Domanski*, Valentin Fuster, Francisco Diaz-Mitoma, Scott Grundy, Donald Lloyd-Jones, Muhammad Mamdani, Robin Roberts, Kevin Thorpe, Judith Hall, Jacob A. Udell, Michael E. Farkouh

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

47 Scopus citations


Atherosclerotic cardiovascular disease (ASCVD) events, including coronary heart disease and stroke, are the most frequent cause of death and major disability in the world. Current American College of Cardiology/American Heart Association primary prevention guidelines are mainly on the basis of randomized controlled trials of statin-based low-density lipoprotein cholesterol (LDL-C)-lowering therapy for primary prevention of ASCVD events. Despite the clear demonstration of statin-based LDL-C lowering, substantial 10-year and lifetime risks of incident ASCVD continue. Although the 10-year risk is low in young and middle-aged adults who would not be treated according to current guidelines, they ultimately account for most incident ASCVD. If statin-based LDL-C lowering were initiated in them at an age before complex coronary plaques are common in the population, a substantial reduction in lifetime risk of incident coronary heart disease might be achieved. We examine this hypothesis and introduce the design of a currently recruiting trial to address it.

Original languageEnglish (US)
Pages (from-to)1828-1836
Number of pages9
JournalJournal of the American College of Cardiology
Issue number16
StatePublished - Oct 20 2015


  • atherosclerosis
  • atherosclerotic
  • cholesterol
  • hydroxymethylglutaryl-CoA reductase inhibitors
  • plaque
  • primary prevention

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


Dive into the research topics of 'Next steps in primary prevention of coronary heart disease rationale for and design of the ECAD Trial'. Together they form a unique fingerprint.

Cite this