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The myth of 'stable' coronary artery disease
Keith A A Fox1, Marco Metra2, João Morais3
1British Heart Foundation Centre for Cardiovascular Sciences, University of Edinburgh, Edinburgh, UK. k.a.a.fox@ed.ac.uk.
Insights
The term "stable" coronary artery disease (CAD) is misleading, as patients face ongoing risks of cardiovascular events due to plaque and systemic factors. A "vulnerable patient" approach better addresses these long-term risks and guides new therapies.
Area of Science:
- Cardiology
- Vascular Medicine
- Atherothrombosis Research
Background:
- Patients with known cardiovascular disease (CVD) are often labeled with "stable" coronary artery disease (CAD).
- This "stable" classification is misleading due to persistent risks of cardiovascular events and diverse risk characteristics.
- Current secondary prevention strategies, including lifestyle changes and medical therapies, do not eliminate these ongoing risks.
Purpose of the Study:
- To challenge the misconception of "stable" CAD.
- To explore the pathophysiology of CAD, emphasizing plaque and systemic factors in cardiovascular events.
- To advocate for a "vulnerable patient" concept to better assess and manage long-term atherothrombotic risks.
Main Methods:
- Review of the pathophysiology of coronary artery disease.
- Analysis of plaque and systemic factors contributing to cardiovascular events.
- Evaluation of current and emerging medical therapies for chronic atherothrombotic disease.
Main Results:
- The concept of "stable" CAD underestimates long-term cardiovascular event risks.
- Both plaque characteristics and systemic factors significantly contribute to atherothrombotic events.
- A "vulnerable patient" perspective is crucial for understanding diverse and future risks.
Conclusions:
- Coronary artery disease is rarely "stable" and carries persistent risks.
- A paradigm shift towards identifying the "vulnerable patient" is necessary.
- Further research into novel medical therapies is essential for reducing cardiovascular events in patients with chronic CAD.
Abstract:
Patients with known cardiovascular disease who have not had a recent acute event are often referred to as having stable coronary artery disease (CAD). The concept of 'stable' CAD is misleading for two important reasons: the continuing risks of cardiovascular events over the longer term and the diverse spectrum of powerful risk characteristics. The risks of cardiovascular events are frequently underestimated and continue to exist, despite current standards of care for secondary prevention, including lifestyle changes, optimal medical therapy, myocardial revascularization and the use of antiplatelet agents to limit thrombosis. In dispelling the myth of 'stable' CAD, we explore the pathophysiology of the disease and the relative contribution of plaque and systemic factors to cardiovascular events. A broader concept of the vulnerable patient, not just the vulnerable plaque, takes into account the diversity and future risks of atherothrombotic events. We also evaluate new and ongoing research into medical therapies aimed at further reducing the risks of cardiovascular events in patients with chronic - but not stable - atherothrombotic disease.