title: The myth of the "vulnerable plaque": transitioning from a focus on individual lesions to atherosclerotic disease burden for coronary artery disease risk assessment.
abstract: The cardiovascular science community has pursued the quest to identify vulnerable atherosclerotic plaque in patients for decades, hoping to prevent acute coronary events. However, despite major advancements in imaging technology that allow visualization of rupture-prone plaques, clinical studies have not demonstrated improved risk prediction compared with traditional approaches. Considering the complex relationship between plaque rupture and acute coronary event risk suggested by pathology studies and confirmed by clinical investigations, these results are not surprising. This review summarizes the evidence supporting a multifaceted hypothesis of the natural history of atherosclerotic plaque rupture. Managing patients at risk of acute coronary events mandates a greater focus on the atherosclerotic disease burden rather than on features of individual plaques.
authors.affiliation: Department of Medicine, Cardiology Division, Johns Hopkins University, Baltimore, Maryland. Electronic address: azadeh1@jhmi.edu.
authors.forename: Armin
authors.initials: A
authors.lastname: Arbab-Zadeh
authors.affiliation: Mount Sinai Medical Center, Icahn School of Medicine, New York, New York.
authors.forename: Valentin
authors.initials: V
authors.lastname: Fuster
mesh_terms: D057791:Cardiac Imaging Techniques / Q000639:trends; D003324:Coronary Artery Disease / Q000150:complications / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D017281:Cost of Illness; D006801:Humans; D058226:Plaque, Atherosclerotic / Q000175:diagnosis / Q000503:physiopathology; D011237:Predictive Value of Tests; D018570:Risk Assessment
keywords: atherosclerosis; coronary heart disease; coronary imaging; prevention