High-Risk Atherosclerotic Plaques: Mechanisms, Imaging, Models, and Therapy
http://www.100md.com
《新英格兰医药杂志》
The fact that cardiovascular disease, for the most part due to atherosclerosis, is the principal killer in Western societies is well known. However, how and why atherosclerotic plaques that develop over many decades rupture in an often unheralded manner — triggering the clinical presentation of an acute coronary syndrome — is still puzzling. High-Risk Atherosclerotic Plaques addresses this problem in a wide-ranging manner with chapters that follow a rational sequence, unfolding the processes involved in plaque rupture, reviewing the efforts to develop animal models of the phenomenon, explaining the different methods devised to identify and study vulnerable plaques, and summarizing the current and future strategies for treatment. This book is best suited for readers familiar with basic concepts about the development and clinical presentation of atherosclerosis who seek a detailed review of the mechanisms leading to the presentation of acute coronary syndromes.
The chapters on pathophysiology review important concepts, some of which are essential for the understanding of acute coronary syndromes. For example, there is appropriate emphasis on the concept that "vulnerable plaque" is a prospective term, used to define a local process that occurs as a consequence of many pathophysiological phenomena throughout the coronary tree. The term "vulnerable patient" may be more accurate to describe the systemic nature of the condition and to generate potential therapeutic methods that could modify the disease process. In general, the description in the book of the pathogenetic mechanisms of plaque rupture is thorough and clear. In some instances, by contrast, the techniques developed to study vulnerable plaques — including intravascular ultrasonography, optical coherence tomography, magnetic resonance imaging, and nuclear imaging — are laid out in unnecessary detail, particularly in the context of a book that focuses on applications, rather than details, of techniques. Nevertheless, these chapters provide the reader with tools to understand the advantages and limitations of these techniques, especially in relation to their investigational use for the identification of changes induced by treatment. Less clear is the pragmatic role these techniques may have in clinical practice, since prospective identification of vulnerable plaques would require screening vast numbers of people, each one serially, for long periods of time. The last chapter, on therapeutic strategies, is comprehensive and up to date and is perhaps one of the pearls of the book.
There are a few signs of poor editing. Similar concepts related to pathophysiology repeated in different chapters become redundant, and two tables containing the same information are included. A chapter on systemic markers of inflammation (e.g., C-reactive protein) would have been desirable, particularly since inflammation is an important component of the pathophysiology and the vulnerable plaque is part of a systemic condition.
The quest to understand and halt the processes that convert a previously quiescent atherosclerotic plaque into one responsible for untoward clinical outcomes is one of the most exciting and potentially rewarding pursuits in cardiovascular medicine. Overall, this book represents a valuable tool for both the novice and the scholar who are interested in this topic and provides an excellent source of reference material.
Julio A. Panza, M.D.
Washington Hospital Center
Washington, DC 20010
julio.a.panza@medstar.net
The chapters on pathophysiology review important concepts, some of which are essential for the understanding of acute coronary syndromes. For example, there is appropriate emphasis on the concept that "vulnerable plaque" is a prospective term, used to define a local process that occurs as a consequence of many pathophysiological phenomena throughout the coronary tree. The term "vulnerable patient" may be more accurate to describe the systemic nature of the condition and to generate potential therapeutic methods that could modify the disease process. In general, the description in the book of the pathogenetic mechanisms of plaque rupture is thorough and clear. In some instances, by contrast, the techniques developed to study vulnerable plaques — including intravascular ultrasonography, optical coherence tomography, magnetic resonance imaging, and nuclear imaging — are laid out in unnecessary detail, particularly in the context of a book that focuses on applications, rather than details, of techniques. Nevertheless, these chapters provide the reader with tools to understand the advantages and limitations of these techniques, especially in relation to their investigational use for the identification of changes induced by treatment. Less clear is the pragmatic role these techniques may have in clinical practice, since prospective identification of vulnerable plaques would require screening vast numbers of people, each one serially, for long periods of time. The last chapter, on therapeutic strategies, is comprehensive and up to date and is perhaps one of the pearls of the book.
There are a few signs of poor editing. Similar concepts related to pathophysiology repeated in different chapters become redundant, and two tables containing the same information are included. A chapter on systemic markers of inflammation (e.g., C-reactive protein) would have been desirable, particularly since inflammation is an important component of the pathophysiology and the vulnerable plaque is part of a systemic condition.
The quest to understand and halt the processes that convert a previously quiescent atherosclerotic plaque into one responsible for untoward clinical outcomes is one of the most exciting and potentially rewarding pursuits in cardiovascular medicine. Overall, this book represents a valuable tool for both the novice and the scholar who are interested in this topic and provides an excellent source of reference material.
Julio A. Panza, M.D.
Washington Hospital Center
Washington, DC 20010
julio.a.panza@medstar.net