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Rodney Badger's avatar

I'm an Interventional Cardiologist and I've been at this since 1983, the early days of simple balloon angioplasty. And as Payam states, my ego/status/tenure/funding is involved in the care of heart disease. I will state that I see the vast majority of my colleagues transition to these new guidelines. Cardiologists are unique in that heart disease is so common, that our procedures have been tested in randomized studies in tens of thousands of patients in all ethnic, age, and economic groups. We tend to listen and adjust. I only place a coronary stent today in the setting of an Acute Coronary Syndrome, i.e. acute MI, unstable angina, or markedly abnormal stress test. Was the procedure done unnecessarily in the past to many patients? Yes. I guess the upside of overutilization of the procedure is that the technology evolved to an incredible high level and now we can effectively treat acute MI's with great success and improvement in outcomes. So there lies the ethical dilema . Yes, it was overutilized, but yes, we are very very good at treating and saving those suffering from a STEMI (ST Elevation Myocardial Infarction).

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Sobshrink's avatar

I am curious to know whether you think there is any role for the calcium score to help in deciding whether to take a statin among those with a moderate risk Framingham score and no history of heart disease. Of course, lifestyle interventions should always be undertaken, but it's hard to know whether a statin will be of benefit in such cases. Thanks!

https://www.medscape.com/viewarticle/971056

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