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Cardiovascular Research 1999 41(2):402-417; doi:10.1016/S0008-6363(98)00279-X
© 1999 by European Society of Cardiology
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Copyright © 1999, European Society of Cardiology

Strategies to achieve coronary arterial plaque stabilization

Ramin Rabbani and Eric J. Topol*

The Cleveland Clinic Foundation, Department of Cardiology, Desk F-25, 9500 Euclid Avenue, Cleveland, OH 44195, USA

* Corresponding author. Tel.: +1-216-445-9490; fax: +1-216-445-9595; e-mail: topole@cesmtp.ccf.org

Acute coronary syndromes result from fissure, erosion or rupture of a vulnerable atherosclerotic plaque. The characteristics of a vulnerable plaque include a large lipid pool, an abundance of inflammatory cells and mediators, a reduced smooth muscle cell and collagen content and a thin overlying fibrous cap. Potential therapeutic strategies at achieving plaque stabilization have targeted these features. Lipid lowering agents, β-adrenergic blockers, angiotensin converting enzyme inhibitors and antioxidants have been shown to reduce the incidence of acute coronary syndromes, presumably through plaque stabilization. Matrix metalloproteinase inhibitors as well as macrolide antibiotics and gene therapy approaches show promise in achieving plaque stabilization. The evidence supporting plaque stabilization by these agents and the mechanisms by which these agents stabilize plaques are discussed in detail in this review.

KEYWORDS Atherosclerosis; Acute coronary syndromes; Plaque rupture; Lipid lowering; Matrix metalloproteinase; Hydroxymethylglutaryl-CoA reductase


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