Identify, Stratify, Modify

Since the mid 1980’s we have emphasized the importance of these three elements in the detection, investigation and management of vascular disease.

By using many different means to identify the presence of vascular disease we are able to find patients who can benefit from vascular investigation and treatment. Atherosclerosis is the term that describes build-up of plaque or lumps of cholesterol and calcium in the arteries of the body. Once identified, that awareness leads to a series of steps that can prevent heart attack, stroke and sudden death.


If you have already had a heart attack or stroke then you almost certainly have vascular disease – thus you are identified. But what if you have not had any such events? We can still detect vascular disease at a stage when treatments can prevent bad outcomes. For example, plaque in any artery demonstrated by ultrasound is proof of vascular disease. You may have had an ultrasound of the neck (carotid artery) or your legs to cheque for plaque. The radiologist may have commented on a chest X-ray that the aorta is dilated or calcified. A CT to check for lung cancer or other conditions may have identified the presence of calcium in the arteries that supply the heart muscle. Any of these is proof of vascular disease. These clues, among others, help us to identify a disease that has a natural history of getting worse over your lifetime. The good news is that we can alter the course of that disease to your advantage. The next step is to Stratify.


Stratify just means to dig deeply enough to determine if your disease is an immediate threat to your life and well being. We have a number of ways to do this but most involve some form of stress testing. LINK HERE. Stress test results are generally categorized as high or low risk outcomes. Low risk means you either have a normal or nearly normal test. The likelihood of a life threatening cardiac event in the foreseeable future is low. High risk tests usually mean that there is a large amount of you heart muscle is not well supplied under stress or that there is more than one area of the heart affected. Sometimes test fall somewhere in between. In that case we usually choose a different test to see if we can sort it out. Once the stratification process is complete we can decide whether medicine alone will be enough for you or whether you might need something else like a stent or bypass surgery.


This is the step where you play a very important role. We can modify (reduce) your risk by getting you started on medications that lower cholesterol (statins usually), prevent clot formation (aspirin or similar drugs), and medications that lower blood pressure. Some conditions benefit from particular forms of drug therapy like ACE inhibitors or Beta Blockers. Together these groups of drugs are sometimes referred to as “The Lifesavers”. Your contribution to the modification process is equally important – attending at cardiac rehab, regular exercise, limiting excess salt in your diet, weight control, cessation of smoking to name a few. Together we can change (modify) the course of your vascular disease for a longer and healthier life.