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Drug Therapies to Prevent Coronary Plaque Rupture and Erosion: Present and Future

  • Chapter
Atherosclerosis: Diet and Drugs

Part of the book series: Handbook of Experimental Pharmacology ((HEP,volume 170))

Abstract

Patients at high risk for coronary heart disease usually have a number of atherosclerotic plaques in their coronary arteries. Some plaques grow inward and, once they have caused a critical degree of luminal stenosis, lead to chronic anginal symptoms. Other plaques grow outward and remain silent unless they disrupt and trigger an acute coronary event. Either type of plaque may become vulnerable to rupture or erosion once they have reached an advanced stage. Typically, a highly stenotic fibrotic plaque is prone to erosion, whereas an advanced lipid-rich thin-cap fibroatheroma is prone to rupture. Because of the multitude and complex nature of the coronary lesions and our inability to detect silent rupture-prone plaques, the best practical approach to prevent acute coronary events is to treat the vulnerable patient, i.e., to eliminate the risk factors of coronary disease. Despite such preventive measures, a sizable number of patients still experience acute coronary events due to plaque erosion or rupture. Thus, there is room for new avenues to pharmacologically stabilize vulnerable plaques. The development of new noninvasive tools to detect the progression and regression of individual non-stenotic rupture-prone plaques will allow testing of such novel pharmacotherapies. Because no specific plaque-targeted therapies are available at present, we give an overview of the current pharmacotherapy to treat the vulnerable patient and also discuss potential novel therapies to prevent acute coronary events.

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Authors and Affiliations

  1. Wihuri Research Institute, Kalliolinnantie 4, 00140, Helsinki, Finland

    P.T. Kovanen, M. Mäyränpää & K.A. Lindstedt

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  1. P.T. Kovanen
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  2. M. Mäyränpää
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  3. K.A. Lindstedt
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  1. Institute of Clinical Chemistry, University Hospital of Zurich, Rämistrasse 100, 8091, Zürich, Switzerland

    Arnold von Eckardstein

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Kovanen, P., Mäyränpää, M., Lindstedt, K. (2005). Drug Therapies to Prevent Coronary Plaque Rupture and Erosion: Present and Future. In: von Eckardstein, A. (eds) Atherosclerosis: Diet and Drugs. Handbook of Experimental Pharmacology, vol 170. Springer, Berlin, Heidelberg. https://doi.org/10.1007/3-540-27661-0_28

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