Muller James E, Tawakol Ahmed, Kathiresan Sekar, Narula Jagat
Harvard Medical School, Boston, Massachusetts, USA.
J Am Coll Cardiol. 2006 Apr 18;47(8 Suppl):C2-6. doi: 10.1016/j.jacc.2005.12.044.
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.
对易损斑块在冠状动脉事件病因中作用的认识进展，再加上新颖的诊断和治疗方法，为防治心血管疾病带来了新的进展机遇。认识到非限流性斑块常引发心脏事件，促使人们开发出有创和无创方法来前瞻性地识别此类斑块。诸如支架置入、光动力疗法和新型药剂等治疗方法正在被考虑作为稳定易损斑块及可能被检测出的患者的手段，从而加强一级和二级预防。尽管该领域前景广阔，但仍有许多问题有待解决，包括动脉粥样硬化过程的局灶性与全身性、检测手段识别其研发目标并证明该目标与临床事件相关的能力，以及特定治疗的疗效。如果能够成功识别并治疗易损斑块及患者，将会带来巨大的临床益处，同时节省成本。
