Cholesterol
Lowering and the Vessel Wall: New Insights and
Future Perspectives
T.
ŠTULC, R. ČEŠKA
Third
Department of Internal Medicine, First Faculty of
Medicine, Charles University, Prague, Czech
Republic
Received July 18, 2000
Accepted January 30, 2001
Summary
The
basis for most acute coronary events is either
rupture or fissuring of unstable atherosclerotic
plaques with subsequent thrombosis leading to
coronary artery occlusion. The development of
atherosclerotic plaques takes several decades,
but the mechanical features determining its
stability and the risk of rupture can change very
rapidly depending on a number of internal
factors. Unstable plaques have a large lipid
core, a thin overlying fibrous cap and an
abundance of inflammatory cells. The most
important factor determining the plaque stability
is the plasma level of atherogenic LDL particles.
Increased levels of these particles cause
endothelial dysfunction with impaired
vasodilatation capacity and prevalence of
vasoconstriction, maintain inflammatory
infiltration of the plaque, impair the strength
of the fibrous cap and facilitate aggregation and
coagulation. Effective lowering of plasma
cholesterol by pharmacological and
non-pharmacological means can revert most of
these processes and increase the plaque's
mechanical stability within several hours to
days. Lipid lowering therapy can therefore
decrease the risk of acute coronary events within
a very short space of time. Thus a radical
decrease in lipid levels, along with modification
of other risk factors, may become the cornerstone
for treatment of acute coronary syndromes, in
addition to being an effective treatment in
primary and secondary prevention of coronary
heart disease (CHD)..
Key
words
Cholesterol
· Atherosclerosis · Endothelial dysfunction ·
Acute coronary syndromes · Cholesterol lowering
· Plaque stability
Reprint
requests
Tomáš
Štulc, M.D., Third Department of Internal
Medicine, First Faculty of Medicine, Charles
University,
U nemocnice 1, CZ-128 21 Prague 2, Czech
Republic, fax : +420-2-2496 2946, e-mail: tstulc@LF1.cuni.cz
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