Stabilisation of atherosclerotic plaques

Seppo Ylä-Herttuala; Jacob Fog Bentzon; Mat Daemen; Erling Falk; Hector M. Garcia-Garcia; Joerg Herrmann; Imo Hoefer; J. Wouter Jukema; Rob Krams; Brenda R. Kwak; Nikolaus Marx; Marek Naruszewicz; Andrew Newby; Gerard Pasterkamp; Patrick W. J. C. Serruys; Johannes Waltenberger; Christian Weber; Lale Tokgözoglu

doi:10.1160/TH10-12-0784

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2011; 106(01): 1-19
DOI: 10.1160/TH10-12-0784

ESC Position Paper

Schattauer GmbH

Stabilisation of atherosclerotic plaques

Position Paper of the European Society of Cardiology (ESC) Working Group on Atherosclerosis and Vascular Biology

Seppo Ylä-Herttuala

¹Chairman of the position paper task force, A.I.Virtanen Institute, University of Eastern Finland, Kuopio, Finland

,

Jacob Fog Bentzon

²Aarhus University Hospital, Aarhus, Denmark

,

Mat Daemen

³Academic Medical Center, Amsterdam, The Netherlands

,

Erling Falk

²Aarhus University Hospital, Aarhus, Denmark

,

Hector M. Garcia-Garcia

⁴Erasmus University, Rotterdam, The Netherlands

,

Joerg Herrmann

⁵Mayo Clinic College of Medicine, Rochester, USA

,

Imo Hoefer

⁶University Medical Center Utrecht, Utrecht, The Netherlands

,

J. Wouter Jukema

⁷Leiden University Medical Center, Leiden, The Netherlands

,

Rob Krams

⁸Chairman of the Working Group of Atherosclerosis and Vascular Biology, Imperial College, London, UK

,

Brenda R. Kwak

⁹University of Geneva, Geneva, Switzerland

,

Nikolaus Marx

¹⁰University Hospital Aachen, Aachen, Germany

,

Marek Naruszewicz

¹¹Medical University of Warsaw, Warsaw, Poland

,

Andrew Newby

¹²Bristol Heart Institute, Bristol, UK

,

Gerard Pasterkamp

⁶University Medical Center Utrecht, Utrecht, The Netherlands

,

Patrick W. J. C. Serruys

⁴Erasmus University, Rotterdam, The Netherlands

,

Johannes Waltenberger

¹³Westfälische Wilhelms Universität, University Hospital Münster, Münster, Germany

,

Christian Weber

¹⁴Ludwig-Maximilians-University Munich, Munich, Germany

,

Lale Tokgözoglu

¹⁵Past Chairman of the Working Group of Atherosclerosis and Vascular Biology, Hacettepe University, Ankara, Turkey

› Author Affiliations

Abstract

Summary

Plaque rupture and subsequent thrombotic occlusion of the coronary artery account for as many as three quarters of myocardial infarctions. The concept of plaque stabilisation emerged about 20 years ago to explain the discrepancy between the reduction of cardiovascular events in patients receiving lipid lowering therapy and the small decrease seen in angiographic evaluation of atherosclerosis. Since then, the concept of a vulnerable plaque has received a lot of attention in basic and clinical research leading to a better understanding of the pathophysiology of the vulnerable plaque and acute coronary syndromes. From pathological and clinical observations, plaques that have recently ruptured have thin fibrous caps, large lipid cores, exhibit outward remodelling and invasion by vasa vasorum. Ruptured plaques are also focally inflamed and this may be a common denominator of the other pathological features. Plaques with similar characteristics, but which have not yet ruptured, are believed to be vulnerable to rupture. Experimental studies strongly support the validity of anti-inflammatory approaches to promote plaque stability. Unfortunately, reliable non-invasive methods for imaging and detection of such plaques are not yet readily available. There is a strong biological basis and supportive clinical evidence that low-density lipoprotein lowering with statins is useful for the stabilisation of vulnerable plaques. There is also some clinical evidence for the usefulness of antiplatelet agents, beta blockers and renin-angiotensin-aldosterone system inhibitors for plaque stabilisation. Determining the causes of plaque rupture and designing diagnostics and interventions to prevent them are urgent priorities for current basic and clinical research in cardiovascular area.

Atherosclerosis - imaging - plaque stabilisation - treatment - vulnerable plaques

Full Text

References

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