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Atherosclerotic Lesions: Vulnerability

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Pan Vascular Medicine

Abstract

Atherosclerosis is the most frequent cause of ischemic heart disease (IHD) and cerebrovascular disease and is thus the leading cause of death in western societies. Atherosclerosis is generally a benign disease and rarely fatal in itself. It is the occurrence of complicating thrombosis, usually precipitated by sudden rupture of the plaque surface, that turns benign atherosclerosis into malignant atherothrombosis.

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References

  1. Falk E, Nobuyoshi M (1996) Differences between atherosclerosis and restenosis. In: Fuster V, Ross R, Topol EJ (eds) Atherosclerosis and coronary artery disease. Lippincott-Raven, New York, pp 683–700

    Google Scholar 

  2. Van der Wal AC, Becker AE, van der Loos CM, Tigges AJ, Das PK (1994) Fibrous and lipid-rich atherosclerotic plaques are part of interchangeable morphologies related to inflammation: a concept. Coron Artery Dis 5:463–469

    PubMed  Google Scholar 

  3. Falk E, Shah PK, Fuster V (1995) Coronary plaque disruption. Circulation 92:657–671

    Article  CAS  PubMed  Google Scholar 

  4. Ball RY, Stowers EC, Burton JH, Cary NR, Skepper JN, Mitchinson MJ (1995) Evidence that the death of macrophage foam cells contributes to the lipid core of atheroma. Atherosclerosis 114:45–54

    Article  CAS  PubMed  Google Scholar 

  5. Kockx MM (1998) Apoptosis in the atherosclerotic plaque: quantitative and qualitative aspects. Arterioscler Thromb Vasc Biol 18:1519–1522

    Article  CAS  PubMed  Google Scholar 

  6. Geng YJ, Libby P (1995) Evidence for apoptosis in advanced human atheroma. Colocalization with interleukin-1 beta-converting enzyme. Am J Pathol 147:251–266

    CAS  PubMed Central  PubMed  Google Scholar 

  7. Mallat Z, Hugel B, Ohan J, Leseche G, Freyssinet JM, Tedgui A (1999) Shed membrane microparticles with procoagulant potential in human atherosclerotic plaques: a role for apoptosis in plaque thrombogenicity. Circulation 99:348–353

    Article  CAS  PubMed  Google Scholar 

  8. Mallat Z, Benamer H, Hugel B, Benessiano J, Steg PG, Freyssinet JM, Tedgui A (2000) Elevated levels of shed membrane microparticles with procoagulant potential in the peripheral circulating blood of patients with acute coronary syndromes. Circulation 101:841–843

    Article  CAS  PubMed  Google Scholar 

  9. Arroyo LH, Lee RT (1999) Mechanisms of plaque rupture: mechanical and biologic interactions. Cardiovasc Res 41:369–375

    Article  CAS  PubMed  Google Scholar 

  10. Ross R (1997) The pathogenesis of atherosclerosis. In: Braunwald E (ed) Heart disease. A textbook of cardiovascular medicine. Saunders, Philadelphia, pp 1105–1125

    Google Scholar 

  11. Libby P, Geng YJ, Sukhova GK, Simon DI, Lee RT (1997) Molecular determinants of atherosclerotic plaque vulnerability. Ann NY Acad Sci 811:134–142

    Article  CAS  PubMed  Google Scholar 

  12. Falk E, Fuster V, Shah PK (1998) Interrelationship between atherosclerosis and thrombosis. In: Verstraete M, Fuster V, Topol EJ (eds) Cardiovascular thrombosis: thrombocardiology and thromboneu-rology. Lippincott-Raven, Philadelphia, pp 45–58

    Google Scholar 

  13. Zhou J, Chew M, Ravn HB, Falk E (1999) Plaque pathology and coronary thrombosis in the pathogenesis of acute coronary syndromes. Scand J Clin Lab Invest Suppl 230:3–11

    CAS  PubMed  Google Scholar 

  14. Gertz SD, Roberts WC (1990) Hemodynamic shear force in rupture of coronary arterial atherosclerotic plaques. Am J Cardiol 66:1368–1372

    Article  CAS  PubMed  Google Scholar 

  15. Davies MJ, Richardson PD, Woolf N, Katz DR, Mann J (1993) Risk of thrombosis in human atherosclerotic plaques: role of extracellular lipid, macrophage, and smooth muscle cell content. Br Heart J 69:377–381

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  16. Loree HM, Tobias BJ, Gibson LJ, Kamm RD, Small DM, Lee RT (1994) Mechanical properties of model atherosclerotic lesion lipid pools. Arterioscler Thromb 14:230–234

    Article  CAS  PubMed  Google Scholar 

  17. Loree HM, Kamm RD, Stringfellow RG, Lee RT (1992) Effects of fibrous cap thickness on peak circumferential stress in model atherosclerotic vessels. Circ Res 71:850–858

    Article  CAS  PubMed  Google Scholar 

  18. Richardson PD, Davies MJ, Born GV (1989) Influence of plaque configuration and stress distribution on Assuring of coronary atherosclerotic plaques. Lancet 2(8669):941–944

    Article  CAS  PubMed  Google Scholar 

  19. Lendon CL, Davies MJ, Richardson PD, Born GV (1993) Testing of small connective tissue specimens for the determination of the mechanical behaviour of atherosclerotic plaques. J Biomed Eng 15: 27–33

    Article  CAS  PubMed  Google Scholar 

  20. Weissberg PL (2000) Atherogenesis: current understanding of the causes of atheroma. Heart 83:247–252

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  21. Kockx MM, De Meyer GR, Muhring J, Jacob W, Bult H, Herman AG (1998) Apoptosis and related proteins in different stages of human atherosclerotic plaques. Circulation 97:2307–2315

    Article  CAS  PubMed  Google Scholar 

  22. Kockx MM, Herman AG (2000) Apoptosis in atherosclerosis: beneficial or detrimental? Cardiovasc Res 45:736–746

    Article  CAS  PubMed  Google Scholar 

  23. van der Wal AC, Becker AE, van der Loos CM, Das PK (1994) Site of intimai rupture or erosion of thrombosed coronary atherosclerotic plaques is characterized by an inflammatory process irrespective of the dominant plaque morphology. Circulation 89:36–44

    Article  PubMed  Google Scholar 

  24. Moreno PR, Falk E, Palacios IF, Newell JB, Fuster V, Fallon JT (1994) Macrophage infiltration in acute coronary syndromes. Implications for plaque rupture. Circulation 90:775–778

    Article  CAS  PubMed  Google Scholar 

  25. Boyle JJ (1997) Association of coronary plaque rupture and atherosclerotic inflammation. J Pathol 181:93–99

    Article  CAS  PubMed  Google Scholar 

  26. Libby P (1998) The interface of atherosclerosis and thrombosis: basic mechanisms. Vasc Med 3:225–229

    Article  CAS  PubMed  Google Scholar 

  27. Shah PK (1999) Plaque disruption and thrombosis. Potential role of inflammation and infection. Cardiol Clin 17:271–281

    Article  CAS  PubMed  Google Scholar 

  28. de Boer OJ, van der Wal AC, Teeling P, Becker AE (1999) Leucocyte recruitment in rupture-prone regions of lipid-rich plaques: a prominent role for neovascularization? Cardiovasc Res 41:443–449

    Article  PubMed  Google Scholar 

  29. Shah PK, Falk E, Badimon JJ, Fernandez-Ortiz A, Mailhac A, Villareal-Levy G, Fallon JT, Regnstrom J, Fuster V (1995) Human monocyte-derived macrophages induce collagen breakdown in fibrous caps of atherosclerotic plaques. Potential role of matrix-degrading metallo-proteinases and implications for plaque rupture. Circulation 92:1565–1569

    CAS  PubMed  Google Scholar 

  30. Galis ZS, Muszynski M, Sukhova GK, Simon-Morrissey E, Unemori EN, Lark MW, Amento E, Libby P (1994) Cytokine-stimulated human vascular smooth muscle cells synthesize a complement of enzymes required for extracellular matrix digestion. Circ Res 75: 181–189

    Article  CAS  PubMed  Google Scholar 

  31. Mach F, Schonbeck U, Bonnefoy JY, Pober JS, Libby P (1997) Activation of monocyte/macrophage functions related to acute atheroma complication by ligation of CD40: induction of collagenase, stromelysin, and tissue factor. Circulation 96:396–399

    Article  CAS  PubMed  Google Scholar 

  32. Song YL, Ford JW, Gordon D, Shanley CJ (2000) Regulation of lysyl oxidase by interferon-gamma in rat aortic smooth muscle cells. Arterioscler Thromb Vasc Biol 20:982–988

    Article  CAS  PubMed  Google Scholar 

  33. Mann J, Davies MJ (1999) Mechanisms of progression in native coronary artery disease: role of healed plaque disruption. Heart 82:265–268

    CAS  PubMed Central  PubMed  Google Scholar 

  34. Cheng GC, Loree HM, Kamm RD, Fishbein MC, Lee RT (1993) Distribution of circumferential stress in ruptured and stable atherosclerotic lesions. A structural analysis with histopathological correlation. Circulation 87:1179–1187

    Article  CAS  PubMed  Google Scholar 

  35. Tofler GH (1997) Triggering and the pathophysiology of acute coronary syndromes. Am Heart J 134:S55–S61

    Article  Google Scholar 

  36. Burke AP, Farb A, Malcom GT, Liang Y, Smialek JE, Virmani R (1999) Plaque rupture and sudden death related to exertion in men with coronary artery disease. JAMA 281:921–926

    Article  CAS  PubMed  Google Scholar 

  37. Davies MJ (2000) The pathophysiology of acute coronary syndromes. Heart 83:361–366

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  38. Fernandez-Ortiz A, Badimon JJ, Falk E, Fuster V, Meyer B, Mailhac A, Weng D, Shah PK, Badimon L (1994) Characterization of the relative thrombogenicity of atherosclerotic plaque components: implications for consequences of plaque rupture. J Am Coll Cardiol 23: 1562–1569

    Article  CAS  PubMed  Google Scholar 

  39. Moreno PR, Bernardi VH, Lopez-Cuellar J, Murcia AM, Palacios IF, Gold HK, Mehran R, Sharma SK, Nemerson Y, Fuster V, Fallon JT (1996) Macrophages, smooth muscle cells, and tissue factor in unstable angina. Implications for cell-mediated thrombogenicity in acute coronary syndromes. Circulation 94:3090–3097

    Article  CAS  PubMed  Google Scholar 

  40. Ardissino D, Merlini PA, Ariens R, Coppola R, Bramucci E, Mannucci PM (1997) Tissue-factor antigen and activity in human coronary atherosclerotic plaques. Lancet 349(9054):769–771

    Article  CAS  PubMed  Google Scholar 

  41. Badimon JJ, Lettino M, Toschi V, Fuster V, Berrozpe M, Chesebro JH, Badimon L (1999) Local inhibition of tissue factor reduces the thrombogenicity of disrupted human atherosclerotic plaques: effects of tissue factor pathway inhibitor on plaque thrombogenicity under flow conditions. Circulation 99:1780–1787

    Article  CAS  PubMed  Google Scholar 

  42. Farb A, Burke AP, Tang AL, Liang TY, Mannan P, Smialek J, Virmani R (1996) Coronary plaque erosion without rupture into a lipid core. A frequent cause of coronary thrombosis in sudden coronary death. Circulation 93:1354–1363

    Article  CAS  PubMed  Google Scholar 

  43. Fischer A, Gutstein DE, Fuster V (1999) Thrombosis and coagulation abnormalities in the acute coronary syndromes. Cardiol Clin 17: 283–294

    Article  CAS  PubMed  Google Scholar 

  44. Soejima H, Ogawa H, Yasue H, Kaikita K, Nishiyama K, Misumi K, Takazoe K, Miyao Y, Yoshimura M, Kugiyama K, Nakamura S, Tsuji I, Kumeda K (1999) Heightened tissue factor associated with tissue factor pathway inhibitor and prognosis in patients with unstable angina. Circulation 99:2908–2913

    Article  CAS  PubMed  Google Scholar 

  45. Leatham EW, Bath PM, Tooze JA, Camm AJ (1995) Increased monocyte tissue factor expression in coronary disease. Br Heart J 73:10–13

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  46. Arbustini E, Morbini P, Bello BD, Prati F, Specchia G (1999) From plaque biology to clinical setting. Am Heart J 138:55–60

    Article  Google Scholar 

  47. Falk E, Fuster V (2000) Atherogenesis and its determinants. In: Fuster V, Alexander RW, King SB, Wellens HJJ (eds) Hurst’s the heart, 10th edn. McGraw-Hill, New York

    Google Scholar 

  48. Gutstein DE, Fuster V (1999) Pathophysiology and clinical significance of atherosclerotic plaque rupture. Cardiovasc Res 41:323–33

    Article  CAS  PubMed  Google Scholar 

  49. Falk E (1985) Unstable angina with fatal outcome: dynamic coronary thrombosis leading to infarction and/or sudden death. Autopsy evidence of recurrent mural thrombosis with peripheral embolization culminating in total vascular occlusion. Circulation 71:699–708

    Article  CAS  PubMed  Google Scholar 

  50. Davies MJ, Thomas AC, Knapman PA, Hangartner JR (1986) In-tramyocardial platelet aggregation in patients with unstable angina suffering sudden ischemic cardiac death. Circulation 73:418–427

    Article  CAS  PubMed  Google Scholar 

  51. Topol EJ, Yadav JS (2000) Recognition of the importance of embolization in atherosclerotic vascular disease. Circulation 101:570–580

    Article  CAS  PubMed  Google Scholar 

  52. Greenland P, Abrams J, Aurigemma GP, Bond MG, Clark LT, Criqui MH, Crouse JR III, Friedman L, Fuster V, Herrington DM, Kuller LH, Ridker PM, Roberts WC, Stanford W, Stone N, Swan HJ, Taubert KA, Wexler L (2000) Prevention conference V. Beyond secondary prevention: identifying the high-risk patient for primary prevention: noninvasive tests of atherosclerotic burden. Writing Group III. Circulation 101:E16–E22

    Article  Google Scholar 

  53. Ridker PM (1999) Evaluating novel cardiovascular risk factors: can we better predict heart attacks? Ann Intern Med 130:933–937

    Article  CAS  PubMed  Google Scholar 

  54. Koenig W, Sund M, Frohlich M, Fischer HG, Lowel H, Doring A, Hutchinson WL, Pepys MB (1999) C-reactive protein, a sensitive marker of inflammation predicts future risk of coronary heart disease in initially healthy middle-aged men: results from the MONICA (Monitoring Trends and Determinants in Cardiovascular Disease) Augsburg Cohort Study, 1984 to 1992. Circulation 99:237–242

    Article  CAS  PubMed  Google Scholar 

  55. Ridker PM, Buring JE, Shih J, Matias M, Hennekens CH (1998) Prospective study of C-reactive protein and the risk of future cardiovascular events among apparently healthy women. Circulation 98:731–733

    Article  CAS  PubMed  Google Scholar 

  56. Toss H, Lindahl B, Siegbahn A, Wallentin L (1997) Prognostic influence of increased fibrinogen and C-reactive protein levels in unstable coronary artery disease. FRISC Study Group. Fragmin during Instability in Coronary Artery Disease. Circulation 96:4204–4210

    Article  CAS  PubMed  Google Scholar 

  57. Pasterkamp G, Falk E, Woutman H, Borst C (2000) Techniques characterizing the coronary atherosclerotic plaque: influence on clinical decision making? J Am Coll Cardiol 36:13–21

    Article  CAS  PubMed  Google Scholar 

  58. Fishbein MC, Siegel RJ (1996) How big are coronary atherosclerotic plaques that rupture? Circulation 94:2662–2666

    Article  CAS  PubMed  Google Scholar 

  59. de Korte CL, Cespedes EI, van der Steen AFW, Pasterkamp G, Bom N (1998) Intravascular ultrasound elastography: assessment and imaging of elastic properties of diseased arteries and vulnerable plaque. Eur J Ultrasound 7:219–224

    Article  PubMed  Google Scholar 

  60. Wexler L, Brundage B, Crouse J, Detrano R, Fuster V, Maddahi J, Rumberger J, Stanford W, White R, Taubert K (1996) Coronary artery calcification: pathophysiology, epidemiology, imaging methods, and clinical implications. A statement for health professionals from the American Heart Association Writing Group. Circulation 94: 1175–1192

    Article  CAS  PubMed  Google Scholar 

  61. Sangiorgi G, Rumberger JA, Severson A, Edwards WD, Gregoire J, Fitzpatrick LA, Schwartz RS (1998) Arterial calcification and not lumen stenosis is highly correlated with atherosclerotic plaque burden in humans: a histologic study of 723 coronary artery segments using nondecalcifying methodology. J Am Coll Cardiol 31: 126–133

    Article  CAS  PubMed  Google Scholar 

  62. Kullo IJ, Edwards WD, Schwartz RS (1998) Vulnerable plaque: pathobiology and clinical implications. Ann Intern Med 129:1050–1060

    Article  CAS  PubMed  Google Scholar 

  63. Toussaint JF, LaMuraglia GM, Southern JF, Fuster V, Kantor HL (1996) Magnetic resonance images: lipid, fibrous, calcified, hemorrhagic, and thrombotic components of human atherosclerosis in vivo. Circulation 94:932–938

    Article  CAS  PubMed  Google Scholar 

  64. Fayad ZA, Fallon JT, Shinnar M, Wehrli S, Dansky HM, Poon M, Badimon JJ, Charlton SA, Fisher EA, Breslow JL, Fuster V (1998) Noninvasive in vivo high-resolution magnetic resonance imaging of atherosclerotic lesions in genetically engineered mice. Circulation 98:1541–1547

    Article  CAS  PubMed  Google Scholar 

  65. Fuster V, Fayad ZA, Badimon JJ (1999) Acute coronary syndromes: biology. Lancet 353 [Suppl II]:5–9

    Article  Google Scholar 

  66. Stefanadis C, Diamantopoulos L, Vlachopoulos C, Tsiamis E, Dernellis J, Toutouzas K, Stefanadi E, Toutouzas P (1999) Thermal heterogeneity within human atherosclerotic coronary arteries detected in vivo: a new method of detection by application of a special thermography catheter. Circulation 99:1965–1971

    Article  CAS  PubMed  Google Scholar 

  67. Casscells W, Hathorn B, David M, Krabach T, Vaughn WK, McAllister HA, Bearman G, Willerson JT (1996) Thermal detection of cellular infiltrates in living atherosclerotic plaques: possible implications for plaque rupture and thrombosis. Lancet 347(9013):1447–1451

    Article  CAS  PubMed  Google Scholar 

  68. Rabbani R, Topol EJ (1999) Strategies to achieve coronary arterial plaque stabilization. Cardiovasc Res 41:402–417

    Article  CAS  PubMed  Google Scholar 

  69. Aikawa M, Rabkin E, Okada Y, Voglic SJ, Clinton SK, Brinckerhoff CE, Sukhova GK, Libby P (1998) Lipid lowering by diet reduces matrix metalloproteinase activity and increases collagen content of rabbit atheroma: a potential mechanism of lesion stabilization. Circulation 97:2433–2444

    Article  CAS  PubMed  Google Scholar 

  70. Frishman WH, Lazar EJ (1990) Reduction of mortality, sudden death and non-fatal reinfarction with beta-adrenergic blockers in survivors of acute myocardial infarction: a new hypothesis regarding the cardioprotective action of beta-adrenergic blockade. Am J Cardiol 66:66G–70G

    Article  Google Scholar 

  71. Pfeffer MA, Braunwald E, Moye LA, Basta L, Brown EJ Jr, Cuddy TE, Davis BR, Geltman EM, Goldman S, Flaker GC et al (1992) Effect of Captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction. Results of the survival and ventricular enlargement trial. The SAVE Investigators. N Engl J Med 327:669–677

    Article  CAS  PubMed  Google Scholar 

  72. Anonymous (1991) Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure. The SOLVD Investigators. N Engl J Med 325:293–302

    Google Scholar 

  73. Anonymous (1992) Effect of enalapril on mortality and the development of heart failure in asymptomatic patients with reduced left ventricular ejection fractions. The SOLVD Investigators. N Engl J Med 327:685–691

    Google Scholar 

  74. Yusuf S, Sleight P, Pogue J, Bosch J, Davies R, Dagenais G (2000) Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. The Heart Outcomes Prevention Evaluation Study Investigators. N Engl J Med 342:145–153

    Article  CAS  PubMed  Google Scholar 

  75. Diet F, Pratt RE, Berry GJ, Momose N, Gibbons GH, Dzau VJ (1996) Increased accumulation of tissue ACE in human atherosclerotic coronary artery disease. Circulation 94:2756–2767

    Article  CAS  PubMed  Google Scholar 

  76. Miyazaki M, Sakonjo H, Takai S (1999) Anti-atherosclerotic effects of an angiotensin converting enzyme inhibitor and an angiotensin II antagonist in Cynomolgus monkeys fed a high-cholesterol diet. Br J Pharmacol 128:523–529

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  77. Fukuhara M, Geary RL, Diz DI, Gallagher PE, Wilson JA, Glazier SS, Dean RH, Ferrario CM (2000) Angiotensin-Converting enzyme expression in human carotid artery atherosclerosis. Hypertension 35:353–59

    Article  CAS  PubMed  Google Scholar 

  78. Berkenboom G (1998) Unstable atherosclerotic plaque. Pathophysiology and therapeutic guidelines. Acta Cardiol 53:235–241

    CAS  PubMed  Google Scholar 

  79. Soejima H, Ogawa H, Yasue H, Kaikita K, Takazoe K, Nishiyama K, Misumi K, Miyamoto S, Yoshimura M, Kugiyama K, Nakamura S, Tsuji I (1999) Angiotensin-Converting enzyme inhibition reduces monocyte chemoattractant protein-1 and tissue factor levels in patients with myocardial infarction. J Am Coll Cardiol 34:983–988

    Article  CAS  PubMed  Google Scholar 

  80. Tribble DL (1999) AHA Science Advisory. Antioxidant consumption and risk of coronary heart disease: emphasis on vitamin C, vitamin E, and beta-carotene: a statement for healthcare professionals from the American Heart Association. Circulation 99:591–595

    Article  CAS  PubMed  Google Scholar 

  81. Stampfer MJ, Hennekens CH, Manson JE, Colditz GA, Rosner B, Willett WC (1993) Vitamin E consumption and the risk of coronary disease in women. N Engl J Med 328:1444–1449

    Article  CAS  PubMed  Google Scholar 

  82. Rimm EB, Stampfer MJ, Ascherio A, Giovannucci E, Colditz GA, Willett WC (1993) VitaminE consumption and the risk of coronary heart disease in men. N Engl J Med 328:1450–1456

    Article  CAS  PubMed  Google Scholar 

  83. Anonymous (1999) Dietary supplementation with n-3 polyunsaturated fatty acids and vitamin E after myocardial infarction: results of the GISSI-Prevenzione trial. Gruppo Italiano per lo Studio della Sopravvivenza nell’Infarto miocardico. Lancet 354(9177):447–455

    Google Scholar 

  84. Yusuf S, Dagenais G, Pogue J, Bosch J, Sleight P (2000) VitaminE supplementation and cardiovascular events in high-risk patients. The Heart Outcomes Prevention Evaluation Study Investigators. N Engl J Med 342:154–160

    Article  CAS  PubMed  Google Scholar 

  85. Ridker PM, Cushman M, Stampfer MJ et al (1997) Inflammation, aspirin and the risk of cardiovascular disease in apparently healthy men. N Engl J Med 336:973–979

    Article  CAS  PubMed  Google Scholar 

  86. Gurfinkel EP, Bozovich G (1999) Emerging role of antibiotics in atherosclerosis. Am Heart J 138:S537–S538

    Article  Google Scholar 

  87. Ridker PM, Kundsin RB, Stampfer MJ, Poulin S, Hennekens CH (1999) Prospective study of Chlamydia pneumoniae IgG seropositivity and risks of future myocardial infarction. Circulation 99:1161–1164

    Article  CAS  PubMed  Google Scholar 

  88. Nieto FJ, Folsom AR, Sorlie PD, Grayston JT, Wang SP, Chambless LE (1999) Chlamydia pneumoniae infection and incident of coronary heart disease: the Atherosclerosis Risk in Communities Study. Am J Epidemiol 150:149–156

    Article  CAS  PubMed  Google Scholar 

  89. Anderson JL, Muhlestein JB, Carlquist J, Allen A, Trehan S, Nielson C, Hall S, Brady J, Egger M, Horne B, Lim T (1999) Randomized secondary prevention trial of azithromycin in patients with coronary artery disease and serological evidence for Chlamydia pneumoniae infection: the Azithromycin in Coronary Artery Disease: Elimination of Myocardial Infection with Chlamydia (ACADEMIC) study. Circulation 99:1540–1547

    Article  CAS  PubMed  Google Scholar 

  90. Jackson LA, Smith NL, Heckbert SR, Grayston JT, Siscovick DS, Psaty B (1999) Lack of association between first myocardial infarction and past use of erythromycin, tetracycline, or doxycycline. Emerg Infect Dis 5:281–284

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  91. Epstein SE, Zhu J (1999) Lack of association of infectious agents with risk of future myocardial infarction and stroke. Circulation 100:1366–1368

    Article  CAS  PubMed  Google Scholar 

  92. Koenig W, Rothenbacher D, Hoffmeister A, Miller M, Bode G, Adler G, Hombach V, Marz W, Pepys MB, Brenner H (1999) Infection with Helicobacter pylori is not a major independent risk factor for stable coronary heart disease: lack of a role of cytotoxin-associated protein A-positive strains and absence of a systemic inflammatory response. Circulation 100:2326–2331

    Article  CAS  PubMed  Google Scholar 

  93. Gupta S, Camm AJ (1999) Chronic infection, Chlamydia and coronary heart disease. Kluwer Academic, London

    Book  Google Scholar 

  94. Skotnicki JS, Zask A, Nelson FC, Albright JD, Levin JI (1999) Design and synthetic considerations of matrix metalloproteinase inhibitors. Ann N Y Acad Sci 878:61–72

    Article  CAS  PubMed  Google Scholar 

  95. Desurmont C, Caillaud JM, Emmanuel F, Benoit P, Fruchart JC, Castro G, Branellec D, Heard JM, Duverger N (2000) Complete atherosclerosis regression after human ApoE gene transfer in ApoE-defîcient/nude mice. Arterioscler Thromb Vasc Biol 20:435–442

    Article  CAS  PubMed  Google Scholar 

  96. Tangirala RK, Tsukamoto K, Chun SH, Usher D, Pure E, Rader DJ (1999) Regression of atherosclerosis induced by liver-directed gene transfer of apolipoprotein A-I in mice. Circulation 100:1816–1822

    Article  CAS  PubMed  Google Scholar 

  97. Kristensen SD, Ravn HB, Falk E (1997) Insights into the pathophysiology of unstable coronary artery disease. Am J Cardiol 80:5E–9E

    Article  Google Scholar 

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Korsholm, TL., Lyngdorf, L.G., Falk, E. (2002). Atherosclerotic Lesions: Vulnerability. In: Lanzer, P., Topol, E.J. (eds) Pan Vascular Medicine. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-56225-9_20

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