Multicenter Isradipine Diuretic Atherosclerosis Study (Midas): Rationale, Design, and Description of Trial Patients

Abstract

Diseases caused by atherosclerosis, such as diseases of the heart, are the leading cause of death and disability. For example, in the United States diseases of the heart account for more than 36% of deaths each year. This is so despite the impressive decline in mortality from cardiovascular diseases reported in the United States in recent years. The number of premature deaths attributed to coronary heart disease exceeds 500,000 each year. The number of hospitalizations for acute myocardial infarction is more than 600,000 a year; this is more than one hospital admission every minute of each day throughout the year. In addition, there are many thousands of individuals who suffer from diseases caused by atherosclerosis which are in a stage considered “subclinical;” these people are not counted in the available statistics. Yet, they are just as vulnerable to premature death and disability as those who have overt clinical manifestation of the disease. With the advent of noninvasive diagnostic techniques, such as B-mode ultrasound, these “subclinical” stages of diseases caused by atherosclerosis can be easily identified in population studies. Indeed, this has been done, and the findings are not very encouraging. In a recent report from the Cardiovascular Health Study (CHS), a longitudinal study of 5,000 men and women over the age of 65 years, it was stated that more than 37% of the members of the cohort had evidence of subclinical atherosclerotic diseases, (e.g., common carotid wall thickness in the upper 80th percentile, or carotid artery stenosis of more than 25%), with no history or symptoms of any clinical manifestation of atherosclerosis [1].