From vulnerable plaque to vulnerable patient: a call for new definitions and risk assessment strategies: Part I.

  title={From vulnerable plaque to vulnerable patient: a call for new definitions and risk assessment strategies: Part I.},
  author={Morteza Naghavi and Peter Libby and Erling Falk and S. Ward Casscells and Silvio Litovsky and John A. Rumberger and Juan Jos{\'e} Badim{\'o}n and Christodoulos Stefanadis and Pedro R. Moreno and Gerard Pasterkamp and Zahi A. Fayad and Peter H. Stone and Sergio Waxman and Paolo Raggi and Mohammad Madjid and Alireza Zarrabi and Allen P. Burke and Chun Yuan and Peter J. Fitzgerald and David S Siscovick and Chris L. de Korte and Masanori Aikawa and K. E. Juhani Airaksinen and Gerd Assmann and Christoph R. Becker and James H. Chesebro and Andrew A Farb and Zorina S. Galis and Chris Jackson and Ik‐Kyung Jang and Wolfgang Koenig and Robert A. Lodder and Keith L. March and Jasenka Demirovic and Mohamad Navab and Silvia G. Priori and Mark D. Rekhter and Raymond D. Bahr and Scott M. Grundy and Roxana Mehran and Antonio Colombo and Eric Boerwinkle and Christie M. Ballantyne and William Insull and Robert S. Schwartz and Robert A. Vogel and Patrick Wjc Serruys and G K Hansson and David P. Faxon and Sanjay Kaul and Helmut Drexler and Philip Greenland and James E Muller and Renu Virmani and Paul M. Ridker and Douglas P. Zipes and Prediman K Shah and James T. Willerson},
  volume={108 14},
Atherosclerotic cardiovascular disease results in >19 million deaths annually, and coronary heart disease accounts for the majority of this toll. Despite major advances in treatment of coronary heart disease patients, a large number of victims of the disease who are apparently healthy die suddenly without prior symptoms. Available screening and diagnostic methods are insufficient to identify the victims before the event occurs. The recognition of the role of the vulnerable plaque has opened new… 
Imaging atherosclerosis in the vulnerable patient
  • G. Lucignani
  • Medicine
    European Journal of Nuclear Medicine and Molecular Imaging
  • 2006
The term “vulnerable patient” may be more appropriate to identify subjects with a high likelihood of developing cardiac events in the near future and a method for cumulative risk assessment of vulnerable patients needs to be developed that may include variables based on plaque, blood and myocardial vulnerability.
Preventing future acute coronary events: is the target the so-called vulnerable plaque or the high-risk or vulnerable patient?
The breakthroughs into the pathophysiology of acute coronary syndromes in the past few decades are highlighted and a perspective on current treatments, improved risk stratification and potential technological advances that may impact diagnosis and management is presented.
Detection and Treatment of Vulnerable Plaques and Vulnerable Patients: Novel Approaches to Prevention of Coronary Events
There is growing interest in the possibility that identification and treatment of vulnerable plaques and vulnerable patients can enhance the progress made against coronary artery disease. Innovations
Atherosclerotic Plaque Biomarkers: Beyond the Horizon of the Vulnerable Plaque
Cardiovascular disease (CVD) is the number one cause of death globally, and the majority of CVD is caused by atherosclerosis. Atherosclerosis is a systemic inflammatory disease that leads to
Evaluation and Management of the Vulnerable Plaque
The finding that an individual may harbor coronary plaques with vulnerable characteristics indicates elevated atherosclerotic disease risk and thus justifies a more intensive therapeutic approach.
Impact of Coronary Plaque Vulnerability on Acute Cardiovascular Events – Design of a CT-based 2-year Follow-up Study
A prospective observational study that will perform a complex assessment of the features that characterize unstable coronary lesions, in terms of both local assessment via specific coronary computed tomography angiography markers of coronary plaque vulnerability and systemic approach based on serological markers of systemic inflammation in patients proved to be “vulnerable” by developing acute cardiovascular events.
Clinical implications of vulnerable plaque.
Improved risk stratification, by both noninvasive and invasive means, will be a better assessment of the risk/benefit relationships for the novel therapies that are needed to further reduce the morbidity and mortality of the disease.
From vulnerable plaque to vulnerable patient--Part III: Executive summary of the Screening for Heart Attack Prevention and Education (SHAPE) Task Force report.
Cardiovascular healthcare professionals and policymakers are urged to adopt the SHAPE proposal and its attendant cost-effectiveness as a new strategy to contain the epidemic of atherosclerotic cardiovascular disease and the rising cost of therapies associated with this epidemic.


Is There a Vulnerable Plaque?
The intriguing concept of a vulnerable plaque, as a potential short-term precursor of unstable plaques, derives from the theoretical possibility of identifying those coronary atherosclerotic plaques that might become unstable and thus trigger ACS.
Coronary risk factors and plaque morphology in men with coronary disease who died suddenly.
Among men with coronary disease who die suddenly, abnormal serum cholesterol concentrations - particularly elevated ratios of total cholesterol to HDL cholesterol - predispose patients to rupture of vulnerable plaques, whereas cigarette smoking predisposes patients to acute thrombosis.
Extensive development of vulnerable plaques as a pan-coronary process in patients with myocardial infarction: an angioscopic study.
Coronary plaque disruption.
This review will explore potential mechanisms responsible for the sudden conversion of a stable atherosclerotic plaque to an unstable and life-threatening atherothrombotic lesion—an event known as plaque fissuring, rupture, or disruption.
Who is at risk for atherosclerotic disease? Lessons from intravascular ultrasound.
  • S. Nissen
  • Medicine
    The American journal of medicine
  • 2002
Multiple atherosclerotic plaque rupture in acute coronary syndrome.
It was found that patients with acute coronary syndromes frequently had findings on intravascular ultrasound (IVUS) of ruptured plaques in coronary arteries remote from the artery with the culprit lesion, evidence that there is a period of overall instability throughout the coronary vasculature at the time of the acute coronary syndrome.
Triggers of acute coronary syndromes.
Study of the pathophysiological changes produced by these triggers may provide novel therapeutic and preventive targets by a more thorough understanding of vulnerable plaque disruption and coronary thrombosis.
Triggers, acute risk factors and vulnerable plaques: the lexicon of a new frontier.
Multiple Atherosclerotic Plaque Rupture in Acute Coronary Syndrome: A Three-Vessel Intravascular Ultrasound Study
Although one single lesion is clinically active at the time of ACS, the syndrome seems nevertheless associated with overall coronary instability.
Vulnerable Atherosclerotic Plaque: A Multifocal Disease
The recent proliferation of invasive and noninvasive techniques to locate vulnerable atherosclerotic plaques raises important questions. Will such techniques add useful prognostic information? If so,