Prevention of plaque rupture: a new paradigm of therapy.

Abstract:

:Acute coronary syndromes--unstable angina, myocardial infarction, and sudden cardiac death--are caused by acute disruption of an unstable coronary atheroma. Unstable plaques have three histologic characteristics: a large lipid core, many inflammatory cells, and a thin fibrous cap. Because the unstable plaque is not necessarily obstructive, it may cause no symptoms before rupture. The cellular processes that lead to the characteristic histologic features of unstable plaque have recently been identified. This new understanding of the cell biology of plaque instability suggests new therapeutic strategies: passivation of the endothelium, reduction of low-density lipoprotein (LDL) in the vessel wall by decreasing serum LDL levels or accelerating reverse cholesterol transport, inhibition of LDL oxidation, inhibition of inflammatory cytokine expression, and inhibition of thrombus formation. Although the morbidity and mortality resulting from acute coronary disease have been reduced by more than 50% over the past 30 years, it is reasonable to anticipate further reductions of similar magnitude in the decade ahead.

journal_name

Ann Intern Med

authors

Forrester JS

doi

10.7326/0003-4819-137-10-200211190-00012

subject

Has Abstract

pub_date

2002-11-19 00:00:00

pages

823-33

issue

10

eissn

0003-4819

issn

1539-3704

pii

200211190-00012

journal_volume

137

pub_type

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