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New Opportunities for Identification and Reduction of Coronary Risk

Treatment of Vulnerable Patients, Arteries, and Plaques

James E. Muller, MD^_*,a,_*, Ahmed Tawakol, MD^_*,,b, Sekar Kathiresan, MD^_*,,c and Jagat Narula, MD, PhD, FACC^,d

^_* Harvard Medical School, Boston, Massachusetts
Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts
University of California–Irvine School of Medicine, Irvine, California

Manuscript received September 29, 2005; revised manuscript received November 28, 2005, accepted December 1, 2005.

^_* Reprint requests and correspondence: Dr. James E. Muller, InfraReDx, Inc., 34 Third Avenue, Burlington, Massachusetts 01803. (Email: jmuller{at}infraredx.com).

Advances in the understanding of the role of vulnerable plaque in the causation of coronary events, coupled with novel diagnostic and therapeutic approaches, create a new opportunity for progress against cardiovascular disease. The recognition that non–flow-limiting plaques often produce cardiac events has led to the development of invasive and non-invasive methods to identify such plaques prospectively. Treatments such as stenting, photodynamic therapy, and novel pharmaceutical agents are under consideration as methods to stabilize the vulnerable plaques and patients that might be detected, thereby enhancing both primary and secondary prevention. Despite the promise of the field, many issues remain to be resolved, including the focality versus systemic nature of the atherosclerotic process, the ability of detectors to identify the target for which they were developed and prove that such a target is linked to clinical events, and the efficacy of specific therapy. If vulnerable plaques and patients can be successfully identified and treated, there will be immense clinical benefits, accompanied by cost savings.

Abbreviations and Acronyms   CT = computed tomography   DES = drug-eluting stents   IVUS = intravascular ultrasound   MI = myocardial infarction   MR = magnetic resonance   MSCT = multislice computed tomography   PCI = percutaneous coronary intervention   PROVE IT–TIMI 22 = Pravastatin or Atorvastatin Evaluation and Infection Therapy–Thrombolysis In Myocardial Infarction 22   TCFA = thin-cap fibroatheroma

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