Vulnerable atherosclerotic plaque: clinical implications

Area of Science:

• Cardiology
• Atherosclerosis Research

Background:

• Coronary Artery Disease (CAD) is the leading global cause of mortality and morbidity.
• Acute Coronary Syndrome (ACS), including myocardial infarction, is a catastrophic manifestation of CAD, often unpredictable.
• Current treatments improve CAD management, yet ACS still causes significant sudden death and disability.

Purpose of the Study:

• To explore the prediction and prevention of ACS.
• To investigate the role of vulnerable atherosclerotic plaques in ACS development.
• To highlight potential therapeutic strategies targeting plaque stabilization and rupture prevention.

Main Methods:

• Review of existing studies on CAD, ACS, and atherosclerotic plaque rupture.
• Analysis of autopsy and clinical findings regarding plaque vulnerability.
• Examination of evidence from lipid-lowering and antiplatelet therapy trials.
• Consideration of advanced imaging modalities for plaque diagnosis.

Main Results:

• The majority of ACS events originate from non-obstructive, "vulnerable" atherosclerotic lesions.
• Plaque vulnerability is a systemic process, often involving multiple sites.
• Inflammation plays a pivotal role in the inciting factors of vulnerable plaque rupture.
• Lipid-lowering and antiplatelet therapies demonstrate efficacy in reducing acute coronary events, suggesting plaque stabilization benefits.
• Imaging techniques show promise in identifying vulnerable plaques.

Conclusions:

• Preventing ACS requires understanding and targeting vulnerable plaque rupture.
• Inflammation is a key factor in plaque instability.
• Therapeutic strategies focusing on plaque stabilization and antiplatelet therapy are vital for reducing ACS incidence.
• Future advancements in imaging may enable proactive prevention of acute coronary events.