1. Coronary Heart Disease The Magnitude of the Problem 2004 James T. Willerson, MD Medical Director: Texas Heart Institute Chief Of Cardiology: St. Luke’s Episcopal Hospital Editor: Circulation (1993-2004) President: University of Texas Health Science Center at Houston

2. Cardiovascular Disease in US   13,200,000 Americans have CHD   Myocardial infarction = 7,800,000   Angina pectoris = 6,800,000   Stroke = 4,800,000   1 in 5 males and females has some form of CVD   Since 1900 CVD has been the No. 1 killer in the United States every year but 1918   Nearly 2,600 Americans die of CVD each day, an average of 1 death every 34 seconds   CVD accounted for 38.5% of all deaths or 1 of every 2.6 deaths in the United States in 2001 National Health and Nutrition Examination Survey III [NHANES III, 1988-94]

3. Acute Myocardial Infarctions Evolve Most Frequently From Plaques With Mild to Moderate Obstruction Number of MI patients E Falk, PK Shah, V Fuster. Circulation 1995;92:657

5. Features of Vulnerable Plaques  Large lipid pool (>40% plaque volume)  Thin fibrous cap (<65 μm)  Decreased collagen content of cap  Macrophage infiltration  Activated T cells  Mast cells  Depletion of cap smooth muscle cells  Outward remodeling  Necrotic core  Increased neoangiogenesis  Calcium nodule  Temperature and pH heterogeneity  Mechanical stress

6. Atherosclerotic Vulnerable Plaque

7. Estimated Direct and Indirect Costs (in Billions of Dollars) of Cardiovascular Diseases and Stroke United States: 2004 p42 Source:All estimates prepared by Thomas Thom, NHLBI.

8. 2001 data from the Healthcare Cost and Utilization Project (HCUP) hcup.ahrq.gov

11. Deaths From Diseases of the Heart United States: 1900-2001 p5 Source:CDC/NCHS.

12. Cardiovascular Disease Mortality Trends for Males and Females United States: 1979-2001 p2 Source:CDC/NCHS.

13. Prevalence of Cardiovascular Diseases in Americans Age 20 and Older by Age and Sex NHANES III: 1988-94 p5 Source:CDC/NCHS. Note:These data include CHD, CHF, stroke and hypertension.

14. Prevalence of Coronary Heart Disease by Age and Sex NHANES III: 1988-94 p12 Source:CDC/NCHS.