The new paradigm for coronary artery disease: altering risk factors, atherosclerotic plaques, and clinical prognosis.
The old paradigm states that the greater the stenosis, the greater the risk of cardiac events. Revascularization procedures are the only effective approach to improving prognosis associated with coronary artery disease. In contrast, on the basis of the new paradigm, the nature of the plaque determines the risk of acute cardiovascular events. Dangerous plaques have a lipid-rich core with surrounding inflammation and a thin friable overlying fibrous cap, but they usually appear innocuous on angiography. Effective risk factor modification stabilizes the dangerous plaques and is associated with prompt improvement in endothelial dysfunction and a substantial decrease in the risk of acute cardiovascular events and death.
O'Keefe
J H
JH
Mid America Heart Institute, Kansas City, Missouri, USA.
Conn
R D
RD
Lavie
C J
CJ
Bateman
T M
TM
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000924:Anticholesteremic Agents / Q000627:therapeutic use; D000975:Antioxidants / Q000627:therapeutic use; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000473:pathology* / Q000517:prevention & control; D004730:Endothelium, Vascular / Q000473:pathology* / Q000503:physiopathology; D005080:Exercise Test; D006801:Humans; D006937:Hypercholesterolemia / Q000188:drug therapy; D007249:Inflammation; D008148:Lovastatin / Q000031:analogs & derivatives / Q000627:therapeutic use; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D019821:Simvastatin
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000924:Anticholesteremic Agents; D000975:Antioxidants; D010975:Platelet Aggregation Inhibitors; D008148:Lovastatin; D019821:Simvastatin