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(Circulation. 2006;114:2390-2411.)
© 2006 American Heart Association, Inc.

New Drugs and Technologies

Detection and Treatment of Vulnerable Plaques and Vulnerable Patients

Novel Approaches to Prevention of Coronary Events

Sergio Waxman, MD; Fumiyuki Ishibashi, MD; James E. Muller, MD

From the Department of Cardiovascular Medicine, Lahey Clinic, Burlington, Mass (S.W., F.I.); Tufts University School of Medicine, Boston, Mass (S.W.); and Cardiovascular Division, Massachusetts General Hospital and Harvard Medical School, Boston, Mass (J.E.M.).

Correspondence to Dr Sergio Waxman, Lahey Clinic, 41 Mall Rd, Burlington, MA 01805. E-mail Sergio.Waxman@lahey.org

Key Words: coronary diseasecoronary imaging • prevention • plaque

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
There is growing interest in the possibility that identification and treatment of vulnerable plaques and vulnerable patients can enhance the progress made against coronary artery disease. Innovations in medical therapy—statins and other agents—and novel interventional cardiology techniques—eg, drug-eluting stents—have significantly decreased the morbidity and mortality caused by coronary atherosclerosis. However, coronary events continue to be the leading cause of death in the United States, accounting for >479 000 deaths (1 in 5) in 2003.¹

Improved preventive measures are needed because, for many individuals, sudden coronary death is the first sign of the disorder. And even those who survive an acute coronary syndrome remain at high risk. After successful treatment of the initial culprit lesion by a percutaneous coronary intervention (PCI), the risk of a coronary event from a new lesion is 10% in the following year and 5% in each of the subsequent 4 years^2,3 (Figure 1).

View larger version (15K):   Figure 1. Occurrence of coronary events (revascularization, death, MI, acute coronary syndromes, or congestive heart failure) after PCI in 4 studies of bare-metal stents. In addition to events resulting from stented lesions (solid line), many events are caused by nontarget (vulnerable) plaques (dashed line). Modified from Cutlip et al2 with permission from the American Heart Association. Copyright 2004.

These substantial levels of ongoing morbidity and mortality have led to heightened interest in new methods to prevent coronary events. For primary prevention, the effort has focused on plasma markers and noninvasive testing to identify vulnerable individuals. For secondary prevention, interest has focused . . . [Full Text of this Article]

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