The new pathophysiology of coronary artery disease

Our understanding of coronary artery disease risk and the atherosclerotic p rocess has changed greatly in recent years. For example, it is now known th at angiographically apparent coronary artery plaque is not the major cause of myocardial infarction (MI). Rather, it is unstable, soft plaque that can not be seen angiographically that is prone to rupture and result in infarct ion. Also important are changes in vascular reactivity resulting from diet. Cholesterol levels by themselves reveal little about a patient's coronary artery disease risk. Most infarctions occur in patients who have normal tot al cholesterol levels. At-risk patients can be identified using the ratio o f total-to-high-density lipoprotein (HDL) cholesterol levels. The ratio of triglyceride to HDL cholesterol levels is also important. Simple steps to a ssess patients' risk in practice are outlined. Primary prevention trials de monstrate that coronary artery disease risk can be lowered dramatically wit h diet and drug therapy. (C) 1998 by Excerpta Medica, Inc.