title: The 'perfect storm' and acute coronary syndrome onset: do psychosocial factors play a role?
abstract: The revolution in cardiac care over the past two decades, characterized by emergent revascularization, drug eluting stents, anti-platelet medications, and advanced imaging has had little impact on overall ACS recurrence, or ACS prevention. The "Perfect Storm" refers to a confluence of events and processes, including atherosclerotic plaque, coronary flow dynamics, hemostatic and fibrinolytic function, metabolic and inflammatory conditions, neurohormonal dysregulation, and environmental events that give rise to, and result in an ACS event. In this article we illustrate the limits of the traditional main effect research model, giving a brief description of the current state of knowledge regarding the development of atherosclerotic plaque and the rupturing of these plaques that defines an ACS event. We then apply the Perfect Storm conceptualization to describe a program of research concerning a psychosocial vulnerability factor that contributes to increased risk of recurrent ACS and early mortality, and that has defied our efforts to identify underlying pathophysiology and successfully mount efforts to fully mitigate this risk.
authors.affiliation: Department of Medicine, Center for Cardiovascular Behavioral Health, Columbia University, New York, NY 10032, USA.
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Burg
authors.forename: Donald
authors.initials: D
authors.lastname: Edmondson
authors.forename: Daichi
authors.initials: D
authors.lastname: Shimbo
authors.forename: Jonathan
authors.initials: J
authors.lastname: Shaffer
authors.forename: Ian M
authors.initials: IM
authors.lastname: Kronish
authors.forename: William
authors.initials: W
authors.lastname: Whang
authors.forename: Carmela
authors.initials: C
authors.lastname: Alcántara
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Schwartz
authors.forename: Paul
authors.initials: P
authors.lastname: Muntner
authors.forename: Karina W
authors.initials: KW
authors.lastname: Davidson
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000517:prevention & control / Q000523:psychology*; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000523:psychology* / Q000628:therapy; D003326:Coronary Circulation; D003328:Coronary Thrombosis / Q000401:mortality / Q000523:psychology; D003863:Depression / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000523:psychology* / Q000628:therapy; D006339:Heart Rate; D006801:Humans; D008603:Mental Health; D011379:Prognosis; D012008:Recurrence; D012307:Risk Factors; D012422:Rupture, Spontaneous; D013315:Stress, Psychological / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000523:psychology* / Q000628:therapy