Mechanisms of Acute Coronary Syndromes and Their Implications for Therapy

The notion that heart attacks develop from coronary-artery stenosis is an oversimplification of a process involving lipid metabolism, inflammation, macrophage activation, collagen breakdown, and plaque rupture. These insights are leading to new ideas for treatment and prevention. Atherosclerotic lesions in humans typically form over the course of years to decades, one of the longest incubation periods among human diseases. Despite the chronicity of atherosclerosis, thrombotic complications — the most dreaded clinical consequences of this disease — occur suddenly, and often without warning. Our familiarity with the disease has generally led us to accept this apparent paradox without wonder. What mechanisms explain the abrupt transition from stable ischemic heart disease or asymptomatic atherosclerosis to acute coronary syndromes? This review examines our current understanding of the mechanisms underlying these syndromes. According to the traditional view, progressive stenosis narrows the . . .