Atherothrombosis: epidemiology, pathophysiology, and prevention.
OBJECTIVE
To review the pathophysiology of atherothrombosis (atherosclerosis with superimposed platelet-rich thrombus formation) and the measures that can be taken to prevent its clinical sequelae through lifestyle modifications and pharmacotherapy, with emphasis on the role of antiplatelet agents.


METHODS
Recent (1995-2003) published scientific literature, as identified by the authors through Medline searches using the terms atherothrombosis, pathophysiology, risk factors, prevention, and reviews on treatment.


METHODS
Recent systematic English-language review articles were screened for relevant material.


RESULTS
Atherothrombosis is a generalized and diffuse progressive process affecting multiple vascular beds; its clinical consequences, including acute coronary syndromes (unstable angina, acute myocardial infarction, and sudden cardiac death), ischemic stroke, and peripheral arterial disease, are unpredictable in their time course and potentially life-threatening. Atherothrombosis rather than arterial stenosis appears to account for most of the acute ischemic manifestations of the atherosclerotic process. Interventions that can favorably influence atherosclerotic progression include lifestyle modifications (dietary control, exercise, and smoking cessation) and pharmacotherapy (lipid-lowering, antihypertensive, antiglycemic, and antiplatelet drugs). The pivotal role played by the platelet in thrombus formation provides the rationale for employing antiplatelet drugs with complementary modes of action (e.g., aspirin, clopidogrel) to prevent atherothrombosis.


CONCLUSIONS
Ischemic cerebrovascular, coronary, and peripheral arterial disease can be regarded as diverse manifestations of a common underlying systemic pathology, namely atherothrombosis. Secondary prevention of an ischemic event in an affected arterial bed confers the added benefit of primary prevention against potential ischemic events in other arterial beds.
Munger
Mark A
MA
Department of Pharmacy Practice, College of Pharmacy, University of Utah, Salt Lake City, USA.
Hawkins
David W
DW
D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D001161:Arteriosclerosis / Q000453:epidemiology / Q000473:pathology / Q000517:prevention & control; D002986:Clinical Trials as Topic; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D010595:Pharmacists; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D024382:Professional Role; D012307:Risk Factors; D016540:Smoking Cessation; D013927:Thrombosis / Q000453:epidemiology / Q000473:pathology / Q000517:prevention & control
D000806:Angiotensin-Converting Enzyme Inhibitors; D000960:Hypolipidemic Agents; D010975:Platelet Aggregation Inhibitors