Hetal A. Gandhi, MD

A 67-year-old man with positive results on a stress myocardial perfusion test was found to have isolated anomalous origin of the left anterior descending coronary artery from a separate coronary ostium of the right sinus of Valsalva. This anomalous artery was not stenotic and coursed over the anterior free wall of the right ventricle, in front of the pulmonary artery. It did not appear to have an intra-arterial or intramyocardial course.

Prevention has become an important component in the management of cardiovascular disease, a leading cause of death in the United States. Success with modification of traditional risk factors?hypertension, diabetes, dyslipidemia, smoking, and obesity?has led researchers to investigate additional factors that may identify people at risk for a coronary event. C-reactive protein, the most studied and valuable nonlipid serum marker identified thus far, has shown to predict risk for cardiovascular events. Other risk factors studied include homocysteine, fibrinogen, and low-density lipoprotein oxidation; these have shown some clinical benefit in the early phases of research. Interventions that modify these markers, including statin therapy, may need to be considered. Exciting research is ongoing that may crystallize the role of these novel factors in the management of coronary artery disease.