The Vulnerable Plaque PDF

Preface

It has been three years since our first edition of the Handbook of the Vulnerable Plaque and yet in 2007 atherosclerotic cardiovascular disease continues to account for nearly 20 million deaths annually, and coronary heart disease accounts for the majority of this toll. It is well known that the rupture of vulnerable plaque is responsible for most coronary events; while inflammation has also been recognized as playing a major role in plaque disruption. These insights have helped us to move beyond the stress test and coronary angiogram when attempting to diagnose and treat vulnerable/high-risk plaques. New diagnostic methods for the assessment of plaque are becoming available, especially in the areas of blood sampling, noninvasive imaging, and intracoronary diagnostic devices. Research is also being conducted on multiple invasive coronary artery diagnostic devices to improve plaque characterization. These methods include intravascular MRI, near infrared spectroscopy, nuclear methods, optical coherence tomography, palpography, thermography, and molecular strategies to target delivery of imaging and therapeutic agents. Novel therapeutic approaches are emerging as well, creating the hope that these new agents, which can raise high-density lipoprotein or reduce inflammation, offer additional promise for improved systemic treatment of vulnerable plaques.

The recognition of the vulnerability of plaques as a major cause for heart attacks and sudden cardiac death has been established; yet over the past three years the vulnerable plaque field has evolved and advanced in the understanding of the pathophysiology, mechanisms, and diagnosis of the disease. These advances, together with the understanding of the role of vulnerable plaque in the causation of coronary events, have mandated this second edition of The Vulnerable Plaque. As the field has progressed so has this book. It is no longer a handbook, but a comprehensive, inclusive textbook with the latest developments in the field. This second edition provides new insights into the vulnerable plaque world — including mechanism and pathological findings with an emphasis on diagnostic tools such as biomarkers and noninvasive imaging, and new invasive imaging modalities, some of which have recently completed the first round of clinical testing.

Further, as natural history observational studies are being conducted, interventional cardiologists will find in this book the information it takes to understand the state of the field and the potential diagnostic and therapeutic modalities available to identify and treat the vulnerable patient. Included is information on drug-eluting stents, photodynamic therapy, and systemic therapy beyond statins, including cell therapy. Scientists and vascular biologists will find the latest information on genetics, immunology, and molecular biology.

It our hope that this book will provide insight into the progress made in the field, diagnostic capabilities, and new therapeutic approaches regarding the vulnerable plaque. When discussing the topic vulnerable plaque with colleagues, it has been said that advances in these areas will create the opportunity for progress against acute coronary events. It is imperative that the medical community embrace these advances so that the new knowledge gained can be rapidly translated into the ‘real world' care of our patients.