ATHEROSCLEROSIS - A UNIFYING DISORDER WITH DIVERSE MANIFESTATIONS

The epidemiology, costs, and comorbidities associated with atheroscler osis and the role of newer antiplatelet agents are reviewed. Cardiovas cular disease is the leading cause of death in the United States. More than 60 million Americans have one or more types of cardiovascular di sease. The total annual cost of coronary heart disease has been estima ted at $95 billion. Patients with an existing atherosclerotic disease in one vascular bed are at high risk of having an ischemic vascular ev ent in the same or another vascular bed. Peripheral arterial disease i s a strong marker for underlying cerebrovascular and cardiovascular di sease. The common link among these diseases is atherosclerosis leading to atherothrombosis. Platelets play an integral role in atheroscleros is and the formation of arterial thrombus as well as in subsequent acu te events such as ischemic stroke, myocardial infarction, and vascular death. Arterial thrombosis can be mediated by shear-stress-induced pl atelet aggregation. Currently, only one third to one half of all eligi ble patients with stroke, myocardial infarction, or peripheral arteria l disease receive antiplatelet therapy. Thienopyridines such as ticlop idine and clopidogrel are effective inhibitors of shear-stress-induced and endothelial-injury-induced platelet aggregation. Advances in anti platelet therapy provide an opportunity to use newer antiplatelet agen ts in the prevention of atherosclerosis-related morbidity and mortalit y; therapeutic approaches should be directed toward recognizing athero sclerosis as a generalized disease process and preventing ischemic eve nts in multiple vascular beds.