STROKE STATS Third leading cause of death deaths a year strokes a year stroke survivors Leading cause of adult disability Source: Stroke Facts: 1999 NSA

Prevalence of stroke by age and sex United States: Heart Disease and Stroke Statistics – 2003 Update. Dallas, TX: AHA; 2002.

Adult Treatment Panel II National Cholesterol Education Program Circulation 1994; 89: Kannel WB. J. Cardiovascular Risk 1994; 1: Wilterdink et al., Arch Neurol 1992;49: Criqui et al., N. Engl. J. Med. 1992; 326: Initial event Increase in risk MI Stroke Myocardial infarction times (includes death) times ( includes TIA) Ischemic stroke times (includes angina and sudden death) 9 times PAD 4 times (includes fatal MI & other CHD death) times ( includes TIA) Peripheral vascular Cerebrovascular Coronary artery

Long-term risk of a cardiovascular event following a TIA Clark et al. J Neurol Neurosurg Psychiatry 2003;74: CV death, MI or stroke CHD death or MI Any stroke

Prevalence of IVUS-detected atherosclerotic coronary artery disease 21% 66% 75% 85% 91% >50 Prevalence (%) 262 healthy donor heart transplants Tuzcu EM. Circulation 2001;103:2705 Age (years)

68% 18% 14% Pre-MI Stenosis >70% 50-70% < 50% # patients Ambrose 1985 Little 1988 Nobuyoshi 1991 Giroud 1992 All E Falk, PK Shah, V Fuster. Circulation 1995;92:657 Stenosis severity by angiography of atherosclerotic disease preceding MI

Clinical presentation of atherosclerosis: Just the tip of the iceberg Clinical atherosclerosis CAD CVAPAD Subclinical Hyperinsulinemia Dyslipidemia Inflammation Platelet activation Hypercoagulable Endothelial dysfunction Oxidative stress