Dupuis J
Centre de Recherche, Institut de Cardiologie de Montreal, 5000 est Rue Belanger, Montreal, Quebec, Canada H1T 1C8.
Atheroscler Suppl. 2001 Feb;2(1):9-14. doi: 10.1016/s1567-5688(00)00004-0.
The conventional concepts of the pathogenesis of acute coronary syndromes are changing. High-risk lesions are not necessarily the angiographicaly 'tight' stenoses. Rather, vulnerable lesions are those that are unstable, with a large lipid core and a thin fibrous cap. Plaque instability is closely related to the development of inflammation within the intima and acute coronary syndromes result from rupture of a vulnerable atherosclerotic plaque. Stabilization of lesions by modification of structure and content, rather than simple improvement in the luminal diameter, provides a new therapeutic target. Stabilization may be accomplished through lifestyle changes and appropriate pharmacologic therapy. In the past few years, it has become evident that a major beneficial effect of statins is to induce plaque stability and regression. In fact, statins, in addition to lowering low-density lipoprotein cholesterol, have a variety of pleiotropic, or cholesterol-independent, effects that make them a particularly suitable choice in patients with acute coronary syndromes. Among these are improvements in endothelial function, smooth muscle cells, thrombus formation/platelet function, and inflammation.
急性冠状动脉综合征发病机制的传统观念正在发生变化。高危病变不一定是血管造影显示的“严重”狭窄。相反，易损病变是那些不稳定的病变，具有大的脂质核心和薄的纤维帽。斑块不稳定与内膜内炎症的发展密切相关，急性冠状动脉综合征是由易损动脉粥样硬化斑块破裂所致。通过改变结构和内容来稳定病变，而不是单纯改善管腔直径，提供了一个新的治疗靶点。稳定病变可以通过生活方式改变和适当的药物治疗来实现。在过去几年中，他汀类药物的一个主要有益作用已变得明显，即诱导斑块稳定和消退。事实上，他汀类药物除了降低低密度脂蛋白胆固醇外，还具有多种多效性或非胆固醇依赖性作用，这使其成为急性冠状动脉综合征患者特别合适的选择。其中包括内皮功能、平滑肌细胞、血栓形成/血小板功能和炎症的改善。
