ECONOMIC COSTS

The Vulnerable Atherosclerotic Plaque: Strategies for Diagnosis and Management .

Edited by Renu Virmani, Jagat Narula, Martin B. Leon, and James T. Willerson. 375 pp., illustrated. Malden, MA, Blackwell Futura, 2007. $174.95. ISBN 978-1-4051-5859-6 .

The disruption of atherosclerotic plaque is responsible for more than 75% of acute cardiac events, including myocardial infarction and sudden death. Heart disease has been the leading cause of death in the United States for the past 80 years, and a great majority of these deaths are caused by atherosclerotic coronary artery disease. Epidemiologists tell us that age-standardized mortality rates for myocardial infarction have declined over the past 10 to 15 years. However, the absolute number of deaths from myocardial infarction has actually increased, and now the mortality rate is even higher in women than men. In the United States, approximately 1.1 million people a year have a myocardial infarction, and sudden death occurs in an estimated 500,000 people. Worldwide, cardiovascular disease is the major cause of death in developed countries, and its prevalence is increasing in the developing countries of South America and Asia. The epidemic of obesity and associated type 2 diabetes, in addition to increased smoking among certain populations, is likely to keep atherosclerotic cardiovascular disease a major killer for years to come. The economic costs are high as well — estimated at more than $150 billion in the United States in 2007. .

Michael C. Fishbein, M.D. David Geffen School of Medicine at UCLA Los Angeles, CA 90095