THE 3 MECHANISMS FOR CORONARY-ARTERY DISEASE PROGRESSION - INSIGHTS INTO FUTURE MANAGEMENT

The basic mechanisms of atherosclerotic progression have been well elu cidated during the last few years. Basic experimental and clinical inf ormation has helped define the three stages of progression. In this re view we outline the pathologic and clinical differences between slow, rapid, and intermediate progression. The eight morphologically differe nt lesions (types I, II, III, IV, Va, Vb, Vc, and VI) in their various stages are defined. The relationship between specific type of lesion and chronic endothelial injury, cardiac risk factors, and increased va scular permeability to lipids is noteworthy. In regard to the acute co ronary syndromes, the fate of plaque rupture and our understanding of ''passive'' vs. ''active'' rupture are defined. In addition to the phe nomenon of plaque rupture, the thrombogenicity of atherosclerotic plaq ues in the genesis of coronary syndromes is described. The combination of plaque disruption and a high thrombogenic risk profile-including l ocal and systemic factors-is vital to understanding the genesis of the acute coronary syndromes. In approaching the use of these new insight s to arrest or reverse the atherosclerotic process, it is essential to remember that the disease process starts early in life and takes many years to progress to the symptomatic stage. The future holds promise for the development of preventive strategies to halt the progression o f coronary disease-the number one killer in the United States.