Triggers, acute risk factors and vulnerable plaques: the lexicon of a new frontier

Institute of Prevention of Cardiovascular Disease, Deaconess Hospital, Harvard Medical School, Boston, Massachusetts 02215.

A neglected area of cardiovascular research--study of the mechanisms of acute disease onset-is receiving increased attention. The new interest is based on the undisputed findings that onset of myocardial infarction and sudden cardiac death are more likely soon after awakening, indicating that activities of the patient frequently trigger the diseases. Triggering may occur when stressors produce hemodynamic, vasoconstrictive and prothrombotic forces--acute risk factors--that, in the presence of a vulnerable atherosclerotic plaque, cause plaque disruption and thrombosis. Triggering research may clarify mechanisms and suggest measures to sever the linkage between a potential trigger and its pathologic consequence.

This article has been cited by other articles:

				C. M. Gardner, H. Tan, E. L. Hull, J. B. Lisauskas, S. T. Sum, T. M. Meese, C. Jiang, S. P. Madden, J. D. Caplan, A. P. Burke, et al. Detection of lipid core coronary plaques in autopsy specimens with a novel catheter-based near-infrared spectroscopy system. J. Am. Coll. Cardiol. Img., September 1, 2008; 1(5): 638 - 648. [Abstract] [Full Text] [PDF]

				T. C. Turin, Y. Kita, Y. Murakami, N. Rumana, H. Sugihara, Y. Morita, N. Tomioka, A. Okayama, Y. Nakamura, R. D. Abbott, et al. Higher Stroke Incidence in the Spring Season Regardless of Conventional Risk Factors: Takashima Stroke Registry, Japan, 1988-2001 Stroke, March 1, 2008; 39(3): 745 - 752. [Abstract] [Full Text] [PDF]

				M. Miner Patient Education: The Tapestry of Emotion and Exercise American Journal of Lifestyle Medicine, May 1, 2007; 1(3): 188 - 189. [Abstract] [PDF]

				S. Waxman, F. Ishibashi, and J. E. Muller Detection and Treatment of Vulnerable Plaques and Vulnerable Patients: Novel Approaches to Prevention of Coronary Events Circulation, November 28, 2006; 114(22): 2390 - 2411. [Full Text] [PDF]

				G. H. Tofler and J. E. Muller Triggering of Acute Cardiovascular Disease and Potential Preventive Strategies Circulation, October 24, 2006; 114(17): 1863 - 1872. [Full Text] [PDF]

				R A Kloner Can we trigger an acute coronary syndrome? Heart, August 1, 2006; 92(8): 1009 - 1010. [Full Text] [PDF]

				J. E. Muller, A. Tawakol, S. Kathiresan, and J. Narula New opportunities for identification and reduction of coronary risk treatment of vulnerable patients, arteries, and plaques. J. Am. Coll. Cardiol., April 18, 2006; 47(8 Suppl): C2 - C6. [Abstract] [Full Text] [PDF]

				P. C. Strike and A. Steptoe Behavioral and Emotional Triggers of Acute Coronary Syndromes: A Systematic Review and Critique Psychosom Med, March 1, 2005; 67(2): 179 - 186. [Abstract] [Full Text] [PDF]

				J. Moller, T. Theorell, U. de Faire, A. Ahlbom, and J. Hallqvist Work related stressful life events and the risk of myocardial infarction. Case-control and case-crossover analyses within the Stockholm heart epidemiology programme (SHEEP) J Epidemiol Community Health, January 1, 2005; 59(1): 23 - 30. [Abstract] [Full Text] [PDF]

				R. A. Kloner The "Merry Christmas Coronary" and "Happy New Year Heart Attack" Phenomenon Circulation, December 21, 2004; 110(25): 3744 - 3745. [Full Text] [PDF]

				C.-H. Tsai, F.-W. Lung, and S.-Y. Wang The 1999 Ji-Ji (Taiwan) Earthquake as a Trigger for Acute Myocardial Infarction Psychosomatics, December 1, 2004; 45(6): 477 - 482. [Abstract] [Full Text] [PDF]

				V. Puli, D. Eterovi, D. Miri, L. Giunio, A. Lukin, and D. Fabijani Triggering of Ventricular Tachycardia by Meteorologic and Emotional Stress: Protective Effect of {beta}-Blockers and Anxiolytics in Men and Elderly Am. J. Epidemiol., December 1, 2004; 160(11): 1047 - 1058. [Abstract] [Full Text] [PDF]

				A. Peters, S. von Klot, M. Heier, I. Trentinaglia, A. Hormann, H. E. Wichmann, H. Lowel, and the Cooperative Health Research in the Region of A Exposure to Traffic and the Onset of Myocardial Infarction N. Engl. J. Med., October 21, 2004; 351(17): 1721 - 1730. [Abstract] [Full Text] [PDF]

				A. Zanobetti, M. J. Canner, P. H. Stone, J. Schwartz, D. Sher, E. Eagan-Bengston, K. A. Gates, L. H. Hartley, H. Suh, and D. R. Gold Ambient Pollution and Blood Pressure in Cardiac Rehabilitation Patients Circulation, October 12, 2004; 110(15): 2184 - 2189. [Abstract] [Full Text] [PDF]

				J. A. Schaar, C. L. de Korte, F. Mastik, C. Strijder, G. Pasterkamp, E. Boersma, P. W. Serruys, and A. F.W. van der Steen Characterizing Vulnerable Plaque Features With Intravascular Elastography Circulation, November 25, 2003; 108(21): 2636 - 2641. [Abstract] [Full Text] [PDF]

				M. Naghavi, P. Libby, E. Falk, S. W. Casscells, S. Litovsky, J. Rumberger, J. J. Badimon, C. Stefanadis, P. Moreno, G. Pasterkamp, et al. From Vulnerable Plaque to Vulnerable Patient: A Call for New Definitions and Risk Assessment Strategies: Part I Circulation, October 7, 2003; 108(14): 1664 - 1672. [Abstract] [Full Text] [PDF]

				A. Tawakol and J. Muller Through the looking glass: An angioscopic view of the effect of statin therapyon coronary artery plaques J. Am. Coll. Cardiol., August 20, 2003; 42(4): 687 - 689. [Full Text] [PDF]

				W. J. Kop, A. Vingerhoets, G.-J. Kruithof, and J. S. Gottdiener Risk Factors for Myocardial Infarction During Vacation Travel Psychosom Med, May 1, 2003; 65(3): 396 - 401. [Abstract] [Full Text] [PDF]

				K. Kario, T. G. Pickering, Y. Umeda, S. Hoshide, Y. Hoshide, M. Morinari, M. Murata, T. Kuroda, J. E. Schwartz, and K. Shimada Morning Surge in Blood Pressure as a Predictor of Silent and Clinical Cerebrovascular Disease in Elderly Hypertensives: A Prospective Study Circulation, March 18, 2003; 107(10): 1401 - 1406. [Abstract] [Full Text] [PDF]

				F. J. Schoen and R. F. Padera Jr. Cardiac Surgical Pathology Card. Surg. Adult, January 1, 2003; 2(2003): 119 - 185. [Full Text]

				J. A. Ambrose and E. E. Martinez A New Paradigm for Plaque Stabilization Circulation, April 23, 2002; 105(16): 2000 - 2004. [Abstract] [Full Text] [PDF]

				J. E. Williams, F. J. Nieto, C. P. Sanford, D. J. Couper, H. A. Tyroler, and A. Algra The Association Between Trait Anger and Incident Stroke Risk: The Atherosclerosis Risk in Communities (ARIC) Study * Editorial Comment: The Atherosclerosis Risk in Communities (ARIC) Study Stroke, January 1, 2002; 33(1): 13 - 20. [Abstract] [Full Text] [PDF]

				J Moller, A Ahlbom, J Hulting, F Diderichsen, U de Faire, C Reuterwall, and J Hallqvist Sexual activity as a trigger of myocardial infarction. A case-crossover analysis in the Stockholm Heart Epidemiology Programme (SHEEP) Heart, October 1, 2001; 86(4): 387 - 390. [Abstract] [Full Text] [PDF]

				U. E. Heidland and B. E. Strauer Left Ventricular Muscle Mass and Elevated Heart Rate Are Associated With Coronary Plaque Disruption Circulation, September 25, 2001; 104(13): 1477 - 1482. [Abstract] [Full Text] [PDF]

				J. E. Williams, F. J. Nieto, C. P. Sanford, and H. A. Tyroler Effects of an Angry Temperament on Coronary Heart Disease Risk : The Atherosclerosis Risk in Communities Study Am. J. Epidemiol., August 1, 2001; 154(3): 230 - 235. [Abstract] [Full Text] [PDF]

				M. A. Mittleman, R. A. Lewis, M. Maclure, J. B. Sherwood, and J. E. Muller Triggering Myocardial Infarction by Marijuana Circulation, June 12, 2001; 103(23): 2805 - 2809. [Abstract] [Full Text] [PDF]

				A. Peters, D. W. Dockery, J. E. Muller, and M. A. Mittleman Increased Particulate Air Pollution and the Triggering of Myocardial Infarction Circulation, June 12, 2001; 103(23): 2810 - 2815. [Abstract] [Full Text] [PDF]

				D. R Witte, M. L Bots, A. W Hoes, and D. E Grobbee Cardiovascular mortality in Dutch men during 1996 European football championship: longitudinal population study BMJ, December 23, 2000; 321(7276): 1552 - 1554. [Abstract] [Full Text]

				A. Kamiya, S. Iwase, D. Michikami, Q. Fu, and T. Mano Head-down bed rest alters sympathetic and cardiovascular responses to mental stress Am J Physiol Regulatory Integrative Comp Physiol, August 1, 2000; 279(2): R440 - R447. [Abstract] [Full Text] [PDF]

				J. E. Williams, C. C. Paton, I. C. Siegler, M. L. Eigenbrodt, F. J. Nieto, and H. A. Tyroler Anger Proneness Predicts Coronary Heart Disease Risk : Prospective Analysis From the Atherosclerosis Risk In Communities (ARIC) Study Circulation, May 2, 2000; 101(17): 2034 - 2039. [Abstract] [Full Text] [PDF]

				H.-R Arntz, S.N Willich, C Schreiber, T Bruggemann, R Stern, and H.-P Schultheiss Diurnal, weekly and seasonal variation of sudden death. Population-based analysis of 24061 consecutive cases Eur. Heart J., February 2, 2000; 21(4): 315 - 320. [Abstract] [PDF]

				S Kojima, H Nonogi, Y Miyao, S Miyazaki, Y Goto, A Itoh, S Daikoku, T Matsumoto, I Morii, and C Yutani Is preinfarction angina related to the presence or absence of coronary plaque rupture? Heart, January 1, 2000; 83(1): 64 - 68. [Abstract] [Full Text] [PDF]

				D W JOHNSTON Lifestyle changes after a myocardial infarction Heart, November 1, 1999; 82(5): 543 - 544. [Full Text]

				R. A. Kloner, W. K. Poole, and R. L. Perritt When Throughout the Year Is Coronary Death Most Likely to Occur? : A 12-Year Population-Based Analysis of More Than 220 000 Cases Circulation, October 12, 1999; 100(15): 1630 - 1634. [Abstract] [Full Text] [PDF]

				A. J. Siegel, M. B. Sholar, J. H. Mendelson, S. E. Lukas, M. J. Kaufman, P. F. Renshaw, J. C. McDonald, K. B. Lewandrowski, F. S. Apple, J. J. Stec, et al. Cocaine-Induced Erythrocytosis and Increase in von Willebrand Factor: Evidence for Drug-Related Blood Doping and Prothrombotic Effects Arch Intern Med, September 13, 1999; 159(16): 1925 - 1929. [Abstract] [Full Text] [PDF]

				W. J. Kop Chronic and Acute Psychological Risk Factors for Clinical Manifestations of Coronary Artery Disease Psychosom Med, July 1, 1999; 61(4): 476 - 487. [Abstract] [Full Text] [PDF]

				T. Sheth, C. Nair, J. Muller, and S. Yusuf Increased winter mortality from acute myocardial infarction and stroke: the effect of age J. Am. Coll. Cardiol., June 1, 1999; 33(7): 1916 - 1919. [Abstract] [Full Text] [PDF]

				M. A. Mittleman, D. Mintzer, M. Maclure, G. H. Tofler, J. B. Sherwood, and J. E. Muller Triggering of Myocardial Infarction by Cocaine Circulation, June 1, 1999; 99(21): 2737 - 2741. [Abstract] [Full Text] [PDF]

				T. C. Andrews, J. D. Parker, S. Jacobs, R. Friedman, N. Cummings, G. MacCallum, F. Mannting, G. H. Tofler, W. Carlson, J. E. Muller, et al. Effects of therapy with nifedipine GITS or atenolol on mental stress-induced ischemic left ventricular dysfunction J. Am. Coll. Cardiol., November 15, 1998; 32(6): 1680 - 1686. [Abstract] [Full Text] [PDF]

				P. K Shah Role of inflammation and metalloproteinases in plaque disruption and thrombosis Vascular Medicine, August 1, 1998; 3(3): 199 - 206. [Abstract] [PDF]

				M. Peckova, C. E. Fahrenbruch, L. A. Cobb, and A. P. Hallstrom Circadian Variations in the Occurrence of Cardiac Arrests : Initial and Repeat Episodes Circulation, July 7, 1998; 98(1): 31 - 39. [Abstract] [Full Text] [PDF]

				J. E. Muller, P. G. Kaufmann, R. V. Luepker, M. L. Weisfeldt, P. C. Deedwania, and J. T. Willerson Mechanisms Precipitating Acute Cardiac Events : Review and Recommendations of an NHLBI Workshop Circulation, November 4, 1997; 96(9): 3233 - 3239. [Full Text]

				J. A. Blumenthal, W. Jiang, M. A. Babyak, D. S. Krantz, D. J. Frid, R. E. Coleman, R. Waugh, M. Hanson, M. Appelbaum, C. O'Connor, et al. Stress Management and Exercise Training in Cardiac Patients With Myocardial Ischemia: Effects on Prognosis and Evaluation of Mechanisms Arch Intern Med, October 27, 1997; 157(19): 2213 - 2223. [Abstract] [PDF]

				H. R. Middlekauff, A. H. Nguyen, C. E. Negrao, E. U. Nitzsche, C. K. Hoh, B. A. Natterson, M. A. Hamilton, G. C. Fonarow, A. Hage, and J. D. Moriguchi Impact of Acute Mental Stress on Sympathetic Nerve Activity and Regional Blood Flow in Advanced Heart Failure : Implications for `Triggering' Adverse Cardiac Events Circulation, September 16, 1997; 96(6): 1835 - 1842. [Abstract] [Full Text]

				R. P. Tracy, R. N. Lemaitre, B. M. Psaty, D. G. Ives, R. W. Evans, M. Cushman, E. N. Meilahn, and L. H. Kuller Relationship of C-Reactive Protein to Risk of Cardiovascular Disease in the Elderly: Results From the Cardiovascular Health Study and the Rural Health Promotion Project Arterioscler Thromb Vasc Biol, June 1, 1997; 17(6): 1121 - 1127. [Abstract] [Full Text]

				M. A. Mittleman, M. Maclure, M. Nachnani, J. B. Sherwood, and J. E. Muller Educational Attainment, Anger, and the Risk of Triggering Myocardial Infarction Onset Arch Intern Med, April 14, 1997; 157(7): 769 - 775. [Abstract] [PDF]

				A. J. Hammoudeh and J. I. Haft Coronary-Plaque Rupture in Acute Coronary Syndromes Triggered by Snow Shoveling N. Engl. J. Med., December 26, 1996; 335(26): 2001 - 2002. [Full Text]

				J. A. Ambrose and M. Weinrauch Thrombosis in Ischemic Heart Disease Arch Intern Med, July 8, 1996; 156(13): 1382 - 1394. [Abstract] [PDF]

				S. C. Smith Jr Risk-Reduction Therapy: The Challenge to Change : Presented at the 68th Scientific Sessions of the American Heart Association November 13, 1995 Anaheim, California Circulation, June 15, 1996; 93(12): 2205 - 2211. [Full Text]

				J. E. Muller, M. A. Mittleman, M. Maclure, J. B. Sherwood, G. H. Tofler, and Determinants of Myocardial Infarction Onset Study Triggering Myocardial Infarction by Sexual Activity: Low Absolute Risk and Prevention by Regular Physical Exertion JAMA, May 8, 1996; 275(18): 1405 - 1409. [Abstract] [PDF]

				R. F. DeBusk Sexual Activity Triggering Myocardial Infarction: One Less Thing to Worry About JAMA, May 8, 1996; 275(18): 1447 - 1448. [Abstract] [PDF]

				D. S. Krantz, W. J. Kop, F. H. Gabbay, A. Rozanski, M. Barnard, J. Klein, Y. Pardo, and J. S. Gottdiener Circadian Variation of Ambulatory Myocardial Ischemia : Triggering by Daily Activities and Evidence for an Endogenous Circadian Component Circulation, April 1, 1996; 93(7): 1364 - 1371. [Abstract] [Full Text]

				J. Leor, W. K. Poole, and R. A. Kloner Sudden Cardiac Death Triggered by an Earthquake N. Engl. J. Med., February 15, 1996; 334(7): 413 - 419. [Abstract] [Full Text] [PDF]

				J. E. Muller and R. L. Verrier Triggering of Sudden Death -- Lessons from an Earthquake N. Engl. J. Med., February 15, 1996; 334(7): 460 - 461. [Full Text]

				M. A. Mittleman, M. Maclure, J. B. Sherwood, R. P. Mulry, G. H. Tofler, S. C. Jacobs, R. Friedman, H. Benson, and J. E. Muller Triggering of Acute Myocardial Infarction Onset by Episodes of Anger Circulation, October 1, 1995; 92(7): 1720 - 1725. [Abstract] [Full Text]

				G. H. Tofler, O. C. E. Gebara, M. A. Mittleman, P. Taylor, W. Siegel, F. J. Venditti Jr, C. A. Rasmussen, J. E. Muller, and f. t. C. Investigators Morning Peak in Ventricular Tachyarrhythmias Detected by Time of Implantable Cardioverter/Defibrillator Therapy Circulation, September 1, 1995; 92(5): 1203 - 1208. [Abstract] [Full Text]

				E. Falk, P. K. Shah, and V. Fuster Coronary Plaque Disruption Circulation, August 1, 1995; 92(3): 657 - 671. [Full Text]

				J. E. Muller, G. H. Tofler, and R. L. Verrier Sympathetic Activity as the Cause of the Morning Increase in Cardiac Events : A Likely Culprit, but the Evidence Remains Circumstantial Circulation, May 15, 1995; 91(10): 2508 - 2509. [Full Text]

				E. Braunwald Morning Resistance to Thrombolytic Therapy Circulation, March 1, 1995; 91(5): 1604 - 1606. [Full Text]

				P. R. Moreno, R. A. Lodder, K. R. Purushothaman, W. E. Charash, W. N. O'Connor, and J. E. Muller Detection of Lipid Pool, Thin Fibrous Cap, and Inflammatory Cells in Human Aortic Atherosclerotic Plaques by Near-Infrared Spectroscopy Circulation, February 26, 2002; 105(8): 923 - 927. [Abstract] [Full Text] [PDF]

				R. D. Brook, J. R. Brook, B. Urch, R. Vincent, S. Rajagopalan, and F. Silverman Inhalation of Fine Particulate Air Pollution and Ozone Causes Acute Arterial Vasoconstriction in Healthy Adults Circulation, April 2, 2002; 105(13): 1534 - 1536. [Abstract] [Full Text] [PDF]