Identification of and Management Approaches for the High-Risk Patient

Atherothrombosis is a systemic disease that often involves the coronary, cerebrovascular, and peripheral arterial circulations. The presence of multiple risk factors, even in asymptomatic patients, greatly increases the risk of future cardiovascular disease. Antiplatelet therapy potentially has a valuable role across the full spectrum of atherothrombotic disorders. The role of aspirin is well established, and the benefits of clopidogrel have been demonstrated in clinical trials. The Clopidogrel for High Atherothrombotic Risk and Ischemic Stabilization, Management and Avoidance (CHARISMA) trial is currently under way to determine whether the combination of clopidogrel plus aspirin is superior to aspirin plus placebo in >15,000 patients with stable atherothrombosis. The results of the CHARISMA trial are expected to provide further information on the optimal management of patients with stable atherothrombosis with respect to both antiplatelet therapy and overall management.