Going from immutable to mutable atherosclerotic plaques

Atherosclerotic coronary disease develops over several decades and was once thought to be an inevitable, irreversible consequence of aging. Atherogene sis is an inflammatory response that occurs after injury to the endothelium . Thrombosis, because of either endothelial erosion or plaque disruption, p recipitates acute coronary events. Effective lipid lowering with statins ha s consistently and significantly decreased the risk that acute ischemic eve nts will occur. The beneficial effects of statins likely result not only fr om their lipid-lowering effects but also from mechanisms that influence pla que behavior. Atherosclerotic plaques are not immutable; rather, their stru cture and composition can be altered by therapeutic modification. Ample evi dence from clinical trials supports statin treatment in patients with stabl e coronary disease. Results of recent clinical trials support early treatme nt of high-risk patients with unstable coronary disease; early and aggressi ve statin treatment resulted in fewer recurrent ischemic events in patients with an acute coronary syndrome. Additional studies are needed to confirm the benefit of early statin treatment in patients with unstable coronary di sease and to elucidate the reasons for the occurrence of events in treated patients. Research is also necessary to clarify the role of other lipids, a s well as nonlipid risk factors, in the occurrence of acute ischemic events . (C) 2001 by Excerpta Medica, Inc.