Pharmacologic approaches to the treatment of atherosclerotic arterial obstruction.
Three consecutive periods in the natural history of atherosclerosis are amenable to medical treatment. Plaque development is the main target of prevention, which also aims at slowing the progression of already existing plaques. The control of several established risk factors (high blood cholesterol, high blood pressure, diabetes mellitus, tobacco smoking) has already yielded encouraging benefits, especially in the field of secondary prevention. More efficient prophylaxis is to be expected, either from the further improved control of these classic risk factors with earlier, stronger, and longer interventions or from the correction of newly established causal determinants of atherosclerosis. A plaque manifests itself clinically through progressive or abrupt obstruction of the arterial lumen, which can be avoided or retarded by interventions aimed at reducing thrombosis, at controlling plaque instability (the major cause of thrombosis), and at enhancing arterial remodeling (which allows compensatory enlargement of the arterial lumen). When ischemia has occurred, a third wave of palliative treatments aims at improving energy supply to the organ with compromised vascularization. Classic treatments reduce oxygen consumption or improve oxygen extraction by ischemic tissues. In addition, the design of drugs to enhance the development of collateral channels appears to be promising therapeutic approach.
Capron
L
L
Service de Médecine Vasculaire, Hôpital Broussais, Paris, France.
D000818:Animals; D001157:Arterial Occlusive Diseases / Q000188:drug therapy*; D001161:Arteriosclerosis / Q000188:drug therapy* / Q000517:prevention & control; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D006801:Humans; D007511:Ischemia / Q000188:drug therapy
D002317:Cardiovascular Agents