Chronic multivessel disease: Past, present and future

Public health predictions indicate that the prevalence of cardiovascular disease will reach epidemic levels throughout the world in coming years, principally because of increasing obesity and diabetes in the general population. Numerous studies have confirmed that diabetes will affect morbidity and mortality in patients with complex multivessel disease. The magnitude of the public health problem and the enormous economic costs associated with the treatment and hospitalization of these patients make it essential that clinical studies designed to elucidate the pathophysiological mechanisms underlying the development of clinical atherosclerosis from its subclinical form are carried out, with the aim of identifying treatment that can lead to disease regression. Moreover, it is important that evidence from patient registries, and not only from large clinical studies, is interpreted correctly, so that the most effective therapies can be implemented. Registries are not subject to the same patient inclusion biases as studies and they contain information that is not included in clinical studies. Recent evidence from patient registries indicates that the physician's judgment is a predictive variable for a successful clinical outcome. In addition, clinical studies confirm that medical treatment, when it is well monitored and implemented aggressively, can provide similar benefits to surgery. Using the knowledge that has been gained over the last few decades, we have designed a study, named FREEDOM, that will enable us to use high-resolution imaging to reliably and reproducibly correlate plaque characteristics, including the level of inflammation and the so-called,disease burden,,, with the effectiveness of medical treatment aimed at promoting endogenous defense mechanisms. In this way, we hope to be able to influence atherosclerotic disease in high-risk groups from its early silent phase onwards, to slow its spread, and to alter its clinical epidemiology.