Atherosclerosis, Acute Coronary Events, and Cholesterol-Lowering: A New Paradigm

Abstract

Our current understanding of some mechanisms involved with the occurrence of acute coronary events indicates that coronary atherosclerotic plaques need not develop to the point of stenosis before resulting in an acute event. Recent studies show that the majority of myocardial infarctions result from lesions that are 30–60% stenotic, many of which are not associated with any overt clinical symptoms. Considering that every year in the United States, ≈ 200,000 persons with no previous history of coronary disease die from their first myocardial infarction, a major issue becomes identifying persons at risk for coronary disease. Risk assessment for coronary events is a critical area in terms of moving forward with decision-making for lipid-lowering therapies and developing strategies to reduce acute coronary events, and the morbidity and mortality related to them.