Alawi A. Alsheikh-Ali, MD, MS; Georgios D. Kitsios, MD, PhD; Ethan M. Balk, MD, MPH; Joseph Lau, MD; Stanley Ip, MD
Alsheikh-Ali AA, Kitsios GD, Balk EM, Lau J, Ip S. The Vulnerable Atherosclerotic Plaque: Scope of the Literature. Ann Intern Med. 2010;153:387-395. doi: 10.7326/0003-4819-153-6-201009210-00272
Download citation file:
Published: Ann Intern Med. 2010;153(6):387-395.
The scope of recent literature on the concept of â€œvulnerable plaqueâ€ was reviewed by examining 463 abstracts of primary and review articles identified through MEDLINE (2003 to April 2010). Proposed definition criteria of vulnerable plaque included active inflammation, a thin cap with a large lipid core, endothelial denudation, fissured cap, severe stenosis, or combinations of these findings. In 242 primary studies, histopathology, biomarkers, and imaging of carotid and coronary artery plaques were evaluated for features suggestive of vulnerability. Notably, 89% of these studies were cross-sectional in design and were exclusively conducted in patients with known cardiovascular disease. None of the imaging studies documented whether the identified lesions were responsible for cardiovascular events. Cross-sectional design precludes evaluation of the predictive utility of biomarkers. Because vulnerable plaque is not an established medical diagnosis, no studies have been done that explicitly evaluate the treatment of vulnerable plaques. Few studies examined potential systemic treatments (for example, statins) to modify vulnerability features. Large prospective studies in patients with and without previous cardiovascular events during long follow-up are required to validate this concept.
Appendix Table 2.
Plaque vulnerability features that have been included in the criteria of the vulnerable plaque definition are indicated.
Appendix Table 3.
Appendix Table 4.
Appendix Table 5.
Appendix Table 6.
Appendix Table 7.
The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.
Cardiology, Coronary Heart Disease, Coronary Risk Factors, Dyslipidemia, Emergency Medicine.
Results provided by:
Copyright © 2017 American College of Physicians. All Rights Reserved.
Print ISSN: 0003-4819 | Online ISSN: 1539-3704
Conditions of Use
This PDF is available to Subscribers Only