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Arteriosclerosis, Thrombosis, and Vascular Biology. 1997;17:1859-1867

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(Arteriosclerosis, Thrombosis, and Vascular Biology. 1997;17:1859-1867.)
© 1997 American Heart Association, Inc.


Articles

The Unstable Atheroma

Richard T. Lee; ; Peter Libby

From the Vascular Medicine and Atherosclerosis Unit, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.

Correspondence to Richard T. Lee, MD, Cardiovascular Division, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115. E-mail rtlee@bics.bwh.harvard.edu


Key Words: • unstable lesions • fibrous cap • plaque rupture


*    Introduction
 
For several decades, our understanding of the pathogenesis of unstable atherosclerotic lesions has continued to grow. A consistent picture of unstable plaque structure, inflammation, matrix degradation, and prothrombotic activity is emerging. Meanwhile, the mortality rates for coronary artery disease in the United States have steadily declined.1 Changes in the American life style likely account for much of this decline,2 and we can expect further improvements through the beneficial use of aspirin and cholesterol-lowering therapy in subsets of the population.3 4 5 Many of these improvements were based on careful epidemiological studies, with fundamental vascular biology serving a largely supportive role.

In light of this major clinical progress, it is reasonable to consider whether further basic understanding of the unstable atherosclerotic lesion will be translated into a clinical benefit beyond these recent advances.6 We propose that the basic biology of the unstable lesion will now assume even greater importance for two fundamental reasons. First, even with aspirin and cholesterol-lowering therapy, acute vascular events will continue to be a major cause of morbidity and mortality in developed countries. Performing clinical trials and epidemiological studies in the United States and other developed countries will become more difficult and expensive as the number of patients needed for each study increases. Thus, developing new successful approaches to the prevention of acute vascular syndromes will require a sound understanding of the pathogenesis of lesion destabilization, and proceeding to clinical breakthroughs will require strong justification from vascular biology before clinical trials are undertaken. Second, even as the age-adjusted incidence . . . [Full Text of this Article]




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CirculationHome page
H. Sakamoto, M. Aikawa, C. C. Hill, D. Weiss, W. R. Taylor, P. Libby, and R. T. Lee
Biomechanical Strain Induces Class A Scavenger Receptor Expression in Human Monocyte/Macrophages and THP-1 Cells : A Potential Mechanism of Increased Atherosclerosis in Hypertension
Circulation, July 3, 2001; 104(1): 109 - 114.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
M. Takano, K. Mizuno, K. Okamatsu, S. Yokoyama, T. Ohba, and S. Sakai
Mechanical and structural characteristics of vulnerable plaques: analysis by coronary angioscopy and intravascular ultrasound
J. Am. Coll. Cardiol., July 1, 2001; 38(1): 99 - 104.
[Abstract] [Full Text] [PDF]


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HeartHome page
V. K BHATIA and D. O HASKARD
Markers of inflammation in unstable angina
Heart, June 1, 2001; 85(6): 603 - 604.
[Full Text]


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Eur Heart J SupplHome page
M. Aikawa and P. Libby
Vascular inflammation and activation: new targets for lipid lowering
Eur. Heart J. Suppl., May 1, 2001; 3(suppl_B): B3 - B11.
[Abstract] [PDF]


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Arterioscler. Thromb. Vasc. Bio.Home page
M. Leskinen, Y. Wang, D. Leszczynski, K. A. Lindstedt, and P. T. Kovanen
Mast Cell Chymase Induces Apoptosis of Vascular Smooth Muscle Cells
Arterioscler Thromb Vasc Biol, April 1, 2001; 21(4): 516 - 522.
[Abstract] [Full Text] [PDF]


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Am. J. Pathol.Home page
S. Sugiyama, Y. Okada, G. K. Sukhova, R. Virmani, J. W. Heinecke, and P. Libby
Macrophage Myeloperoxidase Regulation by Granulocyte Macrophage Colony-Stimulating Factor in Human Atherosclerosis and Implications in Acute Coronary Syndromes
Am. J. Pathol., March 1, 2001; 158(3): 879 - 891.
[Abstract] [Full Text] [PDF]


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ANN INTERN MEDHome page
A. A. Parulkar, M. L. Pendergrass, R. Granda-Ayala, T. R. Lee, and V. A. Fonseca
Nonhypoglycemic Effects of Thiazolidinediones
Ann Intern Med, January 2, 2001; 134(1): 61 - 71.
[Abstract] [Full Text] [PDF]


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Arterioscler. Thromb. Vasc. Bio.Home page
S. Peng, W. Guo, J. D. Morrisett, M. T. Johnstone, and J. A. Hamilton
Quantification of Cholesteryl Esters in Human and Rabbit Atherosclerotic Plaques by Magic-Angle Spinning 13C-NMR
Arterioscler Thromb Vasc Biol, December 1, 2000; 20(12): 2682 - 2688.
[Abstract] [Full Text] [PDF]


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Arterioscler. Thromb. Vasc. Bio.Home page
Rainer de Martin, M. Hoeth, R. Hofer-Warbinek, and J. A. Schmid
The Transcription Factor NF-{kappa}B and the Regulation of Vascular Cell Function
Arterioscler Thromb Vasc Biol, November 1, 2000; 20 (11): e83 - e88.
[Abstract] [Full Text] [PDF]


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HeartHome page
C von Birgelen, W Klinkhart, G S Mintz, H Wieneke, D Baumgart, M Haude, T Bartel, S Sack, J Ge, and R Erbel
Size of emptied plaque cavity following spontaneous rupture is related to coronary dimensions, not to the degree of lumen narrowing. A study with intravascular ultrasound in vivo
Heart, November 1, 2000; 84(5): 483 - 488.
[Abstract] [Full Text]


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CirculationHome page
K. J. Haley, C. M. Lilly, J.-H. Yang, Y. Feng, S. P. Kennedy, T. G. Turi, J. F. Thompson, G. H. Sukhova, P. Libby, and R. T. Lee
Overexpression of Eotaxin and the CCR3 Receptor in Human Atherosclerosis : Using Genomic Technology to Identify a Potential Novel Pathway of Vascular Inflammation
Circulation, October 31, 2000; 102(18): 2185 - 2189.
[Abstract] [Full Text] [PDF]


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Arterioscler. Thromb. Vasc. Bio.Home page
H. Obara, A. Takayanagi, J. Hirahashi, K. Tanaka, G. Wakabayashi, K. Matsumoto, M. Shimazu, N. Shimizu, and M. Kitajima
Overexpression of Truncated I{kappa}B{alpha} Induces TNF-{alpha}-Dependent Apoptosis in Human Vascular Smooth Muscle Cells
Arterioscler Thromb Vasc Biol, October 1, 2000; 20(10): 2198 - 2204.
[Abstract] [Full Text] [PDF]


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Am. J. Pathol.Home page
F. D. Kolodgie, J. Narula, A. P. Burke, N. Haider, A. Farb, Y. Hui-Liang, J. Smialek, and R. Virmani
Localization of Apoptotic Macrophages at the Site of Plaque Rupture in Sudden Coronary Death
Am. J. Pathol., October 1, 2000; 157(4): 1259 - 1268.
[Abstract] [Full Text] [PDF]


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FASEB J.Home page
W. DURANTE, L. LIAO, S. V. REYNA, K. J. PEYTON, and A. I. SCHAFER
Physiological cyclic stretch directs L-arginine transport and metabolism to collagen synthesis in vascular smooth muscle
FASEB J, September 1, 2000; 14(12): 1775 - 1783.
[Abstract] [Full Text]


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CirculationHome page
C. L. de Korte, G. Pasterkamp, A. F. W. van der Steen, H. A. Woutman, and N. Bom
Characterization of Plaque Components With Intravascular Ultrasound Elastography in Human Femoral and Coronary Arteries In Vitro
Circulation, August 8, 2000; 102(6): 617 - 623.
[Abstract] [Full Text] [PDF]


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CirculationHome page
H. C. McGill Jr, C. A. McMahan, A. W. Zieske, R. E. Tracy, G. T. Malcom, E. E. Herderick, and J. P. Strong
Association of Coronary Heart Disease Risk Factors With Microscopic Qualities of Coronary Atherosclerosis in Youth
Circulation, July 25, 2000; 102(4): 374 - 379.
[Abstract] [Full Text] [PDF]


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Proc. Natl. Acad. Sci. USAHome page
U. Schonbeck, G. K. Sukhova, K. Shimizu, F. Mach, and P. Libby
Inhibition of CD40 signaling limits evolution of established atherosclerosis in mice
PNAS, June 20, 2000; 97(13): 7458 - 7463.
[Abstract] [Full Text] [PDF]


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J. Biol. Chem.Home page
U. J. F. Tietge, C. Maugeais, W. Cain, D. Grass, J. M. Glick, F. C. de Beer, and D. J. Rader
Overexpression of Secretory Phospholipase A2 Causes Rapid Catabolism and Altered Tissue Uptake of High Density Lipoprotein Cholesteryl Ester and Apolipoprotein A-I
J. Biol. Chem., March 31, 2000; 275(14): 10077 - 10084.
[Abstract] [Full Text] [PDF]


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CirculationHome page
Z. Mallat, H. Benamer, B. Hugel, J. Benessiano, P. G. Steg, J.-M. Freyssinet, and A. Tedgui
Elevated Levels of Shed Membrane Microparticles With Procoagulant Potential in the Peripheral Circulating Blood of Patients With Acute Coronary Syndromes
Circulation, February 29, 2000; 101(8): 841 - 843.
[Abstract] [Full Text] [PDF]


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Circ. Res.Home page
M. D. Rekhter, G. W. Hicks, D. W. Brammer, H. Hallak, E. Kindt, J. Chen, W. S. Rosebury, M. K. Anderson, P. J. Kuipers, and M. J. Ryan
Hypercholesterolemia Causes Mechanical Weakening of Rabbit Atheroma : Local Collagen Loss as a Prerequisite of Plaque Rupture
Circ. Res., January 7, 2000; 86(1): 101 - 108.
[Abstract] [Full Text] [PDF]


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Circ. Res.Home page
Y. Feng, J.-H. Yang, H. Huang, S. P. Kennedy, T. G. Turi, J. F. Thompson, P. Libby, and R. T. Lee
Transcriptional Profile of Mechanically Induced Genes in Human Vascular Smooth Muscle Cells
Circ. Res., December 3, 1999; 85(12): 1118 - 1123.
[Abstract] [Full Text] [PDF]


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Circ. Res.Home page
Z. Mallat, S. Besnard, M. Duriez, V. Deleuze, F. Emmanuel, M. F. Bureau, F. Soubrier, B. Esposito, H. Duez, C. Fievet, et al.
Protective Role of Interleukin-10 in Atherosclerosis
Circ. Res., October 15, 1999; 85 (8): e17 - e24.
[Abstract] [Full Text] [PDF]


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StrokeHome page
C. A. Gunnett, D. J. Berg, F. M. Faraci, and G. Feuerstein
Vascular Effects of Lipopolysaccharide Are Enhanced in Interleukin-10-Deficient Mice • Editorial Comment
Stroke, October 1, 1999; 30(10): 2191 - 2196.
[Abstract] [Full Text] [PDF]


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Arterioscler. Thromb. Vasc. Bio.Home page
A. B. Zaltsman, S. J. George, and A. C. Newby
Increased Secretion of Tissue Inhibitors of Metalloproteinases 1 and 2 From the Aortas of Cholesterol Fed Rabbits Partially Counterbalances Increased Metalloproteinase Activity
Arterioscler Thromb Vasc Biol, July 1, 1999; 19(7): 1700 - 1707.
[Abstract] [Full Text] [PDF]


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Circ. Res.Home page
K. R. Coleman, G. A. Braden, M. C. Willingham, and D. C. Sane
Vitaxin, a Humanized Monoclonal Antibody to the Vitronectin Receptor ({alpha}vß3), Reduces Neointimal Hyperplasia and Total Vessel Area After Balloon Injury in Hypercholesterolemic Rabbits
Circ. Res., June 11, 1999; 84(11): 1268 - 1276.
[Abstract] [Full Text] [PDF]


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Arterioscler. Thromb. Vasc. Bio.Home page
W. Y. Craig, M. W. Rawstron, C. A. Rundell, E. Robinson, S. E. Poulin, L. M. Neveux, P. M. Nishina, and L. M. Keilson
Relationship Between Lipoprotein- and Oxidation-Related Variables and Atheroma Lipid Composition in Subjects Undergoing Coronary Artery Bypass Graft Surgery
Arterioscler Thromb Vasc Biol, June 1, 1999; 19(6): 1512 - 1517.
[Abstract] [Full Text] [PDF]


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CirculationHome page
A. J. Moss, R. E. Goldstein, V. J. Marder, C. E. Sparks, D. Oakes, H. Greenberg, H. J. Weiss, W. Zareba, M. W. Brown, C.-S. Liang, et al.
Thrombogenic Factors and Recurrent Coronary Events
Circulation, May 18, 1999; 99(19): 2517 - 2522.
[Abstract] [Full Text] [PDF]


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Arterioscler. Thromb. Vasc. Bio.Home page
Z. Mallat, C. Heymes, J. Ohan, E. Faggin, G. Leseche, and A. Tedgui
Expression of Interleukin-10 in Advanced Human Atherosclerotic Plaques : Relation to Inducible Nitric Oxide Synthase Expression and Cell Death
Arterioscler Thromb Vasc Biol, March 1, 1999; 19(3): 611 - 616.
[Abstract] [Full Text] [PDF]


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Cardiovasc ResHome page
A. C Newby and A. B Zaltsman
Fibrous cap formation or destruction -- the critical importance of vascular smooth muscle cell proliferation, migration and matrix formation
Cardiovasc Res, February 1, 1999; 41(2): 345 - 360.
[Abstract] [Full Text] [PDF]


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Cardiovasc ResHome page
M. D. Rekhter
Collagen synthesis in atherosclerosis: too much and not enough
Cardiovasc Res, February 1, 1999; 41(2): 376 - 384.
[Abstract] [Full Text] [PDF]


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Cardiovasc ResHome page
M. Braun, P. Pietsch, K. Schror, G. Baumann, and S. B. Felix
Cellular adhesion molecules on vascular smooth muscle cells
Cardiovasc Res, February 1, 1999; 41(2): 395 - 401.
[Abstract] [Full Text] [PDF]


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Cardiovasc ResHome page
R. Rabbani and E. J. Topol
Strategies to achieve coronary arterial plaque stabilization
Cardiovasc Res, February 1, 1999; 41(2): 402 - 417.
[Abstract] [Full Text] [PDF]


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Cardiovasc ResHome page
E. Lutgens, E. D. de Muinck, P. J.E.H.M. Kitslaar, J. H.M. Tordoir, H. J.J. Wellens, and M. J.A.P. Daemen
Biphasic pattern of cell turnover characterizes the progression from fatty streaks to ruptured human atherosclerotic plaques
Cardiovasc Res, February 1, 1999; 41(2): 473 - 479.
[Abstract] [Full Text] [PDF]


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NEJMHome page
R. Ross
Atherosclerosis -- An Inflammatory Disease
N. Engl. J. Med., January 14, 1999; 340(2): 115 - 126.
[Full Text] [PDF]


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Arterioscler. Thromb. Vasc. Bio.Home page
G. Pasterkamp, A. H. Schoneveld, A. C. van der Wal, D.-J. Hijnen, W. J. A. van Wolveren, S. Plomp, H. L. J. M. Teepen, and C. Borst
Inflammation of the Atherosclerotic Cap and Shoulder of the Plaque Is a Common and Locally Observed Feature in Unruptured Plaques of Femoral and Coronary Arteries
Arterioscler Thromb Vasc Biol, January 1, 1999; 19(1): 54 - 58.
[Abstract] [Full Text] [PDF]


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Circ. Res.Home page
M. D. Rekhter, G. W. Hicks, D. W. Brammer, C. W. Work, J.-S. Kim, D. Gordon, J. A. Keiser, and M. J. Ryan
Animal Model That Mimics Atherosclerotic Plaque Rupture
Circ. Res., October 5, 1998; 83(7): 705 - 713.
[Abstract] [Full Text] [PDF]


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Circ. Res.Home page
N. Kume, T. Murase, H. Moriwaki, T. Aoyama, T. Sawamura, T. Masaki, and T. Kita
Inducible Expression of Lectin-like Oxidized LDL Receptor-1 in Vascular Endothelial Cells
Circ. Res., August 10, 1998; 83(3): 322 - 327.
[Abstract] [Full Text] [PDF]