From Vulnerable Plaque to Vulnerable Patient

A Call for New Definitions and Risk Assessment Strategies: Part II

Morteza Naghavi, Peter Libby, Erling Falk, S. Ward Casscells, Silvio Litovsky, John Rumberger, Juan Jose Badimon, Christodoulos Stefanadis, Pedro Moreno, Gerard Pasterkamp, Zahi Fayad, Peter H. Stone, Sergio Waxman, Paolo Raggi, Mohammad Madjid, Alireza Zarrabi, Allen Burke, Chun Yuan, Peter J. Fitzgerald, David S. Siscovick & 38 others Chris L. De Korte, Masanori Aikawa, K. E Juhani Airaksinen, Gerd Assmann, Christoph R. Becker, James H. Chesebro, Andrew Farb, Zorina S. Galis, Chris Jackson, Ik Kyung Jang, Wolfgang Koenig, Robert A. Lodder, Keith March, Jasenka Demirovic, Mohamad Navab, Silvia G. Priori, Mark D. Rekhter, Raymond Bahr, Scott M. Grundy, Roxana Mehran, Antonio Colombo, Eric Boerwinkle, Christie Ballantyne, William Insull, Robert S. Schwartz, Robert Vogel, Patrick W. Serruys, Goran K. Hansson, David P. Faxon, Sanjay Kaul, Helmut Drexler, Philip Greenland, James E. Muller, Renu Virmani, Paul M. Ridker, Douglas P. Zipes, Prediman K. Shah, James T. Willerson

Research output: Contribution to journalArticle

1160 Citations (Scopus)

Abstract

Atherosclerotic cardiovascular disease results in > 19 million deaths annually, and coronary heart disease accounts for the majority of this toll. Despite major advances in treatment of coronary heart disease patients, a large number of victims of the disease who are apparently healthy die suddenly without prior symptoms. Available screening and diagnostic methods are insufficient to identify the victims before the event occurs. The recognition of the role of the vulnerable plaque has opened new avenues of opportunity in the field of cardiovascular medicine. This consensus document concludes the following. (1) Rupture-prone plaques are not the only vulnerable plaques. All types of atherosclerotic plaques with high likelihood of thrombotic complications and rapid progression should be considered as vulnerable plaques. We propose a classification for clinical as well as pathological evaluation of vulnerable plaques. (2) Vulnerable plaques are not the only culprit factors for the development of acute coronary syndromes, myocardial infarction, and sudden cardiac death. Vulnerable blood (prone to thrombosis) and vulnerable myocardium (prone to fatal arrhythmia) play an important role in the outcome. Therefore, the term "vulnerable patient" may be more appropriate and is proposed now for the identification of subjects with high likelihood of developing cardiac events in the near future. (3) A quantitative method for cumulative risk assessment of vulnerable patients needs to be developed that may include variables based on plaque, blood, and myocardial vulnerability. In Part I of this consensus document, we cover the new definition of vulnerable plaque and its relationship with vulnerable patients. Part II of this consensus document will focus on vulnerable blood and vulnerable myocardium and provide an outline of overall risk assessment of vulnerable patients. Parts I and II are meant to provide a general consensus and overviews the new field of vulnerable patient. Recently developed assays (eg, C-reactive protein), imaging techniques (eg, CT and MRI), noninvasive electrophysiological tests (for vulnerable myocardium), and emerging catheters (to localize and characterize vulnerable plaque) in combination with future genomic and proteomic techniques will guide us in the search for vulnerable patients. It will also lead to the development and deployment of new therapies and ultimately to reduce the incidence of acute coronary syndromes and sudden cardiac death. We encourage healthcare policy makers to promote translational research for screening and treatment of vulnerable patients.

Original languageEnglish
Pages (from-to)1772-1778
Number of pages7
JournalCirculation
Volume108
Issue number15
DOIs
StatePublished - Oct 14 2003
Externally publishedYes

Fingerprint

Myocardium
Sudden Cardiac Death
Acute Coronary Syndrome
Coronary Disease
Translational Medical Research
Atherosclerotic Plaques
Administrative Personnel
C-Reactive Protein
Proteomics
Cardiac Arrhythmias
Rupture
Thrombosis
Cardiovascular Diseases
Therapeutics
Catheters
Myocardial Infarction
Medicine
Delivery of Health Care
Incidence

Keywords

  • Atherosclerosis
  • Coronary disease
  • Death
  • Myocardial infarction
  • Plaque
  • Sudden

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Naghavi, M., Libby, P., Falk, E., Casscells, S. W., Litovsky, S., Rumberger, J., ... Willerson, J. T. (2003). From Vulnerable Plaque to Vulnerable Patient: A Call for New Definitions and Risk Assessment Strategies: Part II. Circulation, 108(15), 1772-1778. https://doi.org/10.1161/01.CIR.0000087481.55887.C9

From Vulnerable Plaque to Vulnerable Patient : A Call for New Definitions and Risk Assessment Strategies: Part II. / Naghavi, Morteza; Libby, Peter; Falk, Erling; Casscells, S. Ward; Litovsky, Silvio; Rumberger, John; Badimon, Juan Jose; Stefanadis, Christodoulos; Moreno, Pedro; Pasterkamp, Gerard; Fayad, Zahi; Stone, Peter H.; Waxman, Sergio; Raggi, Paolo; Madjid, Mohammad; Zarrabi, Alireza; Burke, Allen; Yuan, Chun; Fitzgerald, Peter J.; Siscovick, David S.; De Korte, Chris L.; Aikawa, Masanori; Airaksinen, K. E Juhani; Assmann, Gerd; Becker, Christoph R.; Chesebro, James H.; Farb, Andrew; Galis, Zorina S.; Jackson, Chris; Jang, Ik Kyung; Koenig, Wolfgang; Lodder, Robert A.; March, Keith; Demirovic, Jasenka; Navab, Mohamad; Priori, Silvia G.; Rekhter, Mark D.; Bahr, Raymond; Grundy, Scott M.; Mehran, Roxana; Colombo, Antonio; Boerwinkle, Eric; Ballantyne, Christie; Insull, William; Schwartz, Robert S.; Vogel, Robert; Serruys, Patrick W.; Hansson, Goran K.; Faxon, David P.; Kaul, Sanjay; Drexler, Helmut; Greenland, Philip; Muller, James E.; Virmani, Renu; Ridker, Paul M.; Zipes, Douglas P.; Shah, Prediman K.; Willerson, James T.

In: Circulation, Vol. 108, No. 15, 14.10.2003, p. 1772-1778.

Research output: Contribution to journalArticle

Naghavi, M, Libby, P, Falk, E, Casscells, SW, Litovsky, S, Rumberger, J, Badimon, JJ, Stefanadis, C, Moreno, P, Pasterkamp, G, Fayad, Z, Stone, PH, Waxman, S, Raggi, P, Madjid, M, Zarrabi, A, Burke, A, Yuan, C, Fitzgerald, PJ, Siscovick, DS, De Korte, CL, Aikawa, M, Airaksinen, KEJ, Assmann, G, Becker, CR, Chesebro, JH, Farb, A, Galis, ZS, Jackson, C, Jang, IK, Koenig, W, Lodder, RA, March, K, Demirovic, J, Navab, M, Priori, SG, Rekhter, MD, Bahr, R, Grundy, SM, Mehran, R, Colombo, A, Boerwinkle, E, Ballantyne, C, Insull, W, Schwartz, RS, Vogel, R, Serruys, PW, Hansson, GK, Faxon, DP, Kaul, S, Drexler, H, Greenland, P, Muller, JE, Virmani, R, Ridker, PM, Zipes, DP, Shah, PK & Willerson, JT 2003, 'From Vulnerable Plaque to Vulnerable Patient: A Call for New Definitions and Risk Assessment Strategies: Part II', Circulation, vol. 108, no. 15, pp. 1772-1778. https://doi.org/10.1161/01.CIR.0000087481.55887.C9
Naghavi, Morteza ; Libby, Peter ; Falk, Erling ; Casscells, S. Ward ; Litovsky, Silvio ; Rumberger, John ; Badimon, Juan Jose ; Stefanadis, Christodoulos ; Moreno, Pedro ; Pasterkamp, Gerard ; Fayad, Zahi ; Stone, Peter H. ; Waxman, Sergio ; Raggi, Paolo ; Madjid, Mohammad ; Zarrabi, Alireza ; Burke, Allen ; Yuan, Chun ; Fitzgerald, Peter J. ; Siscovick, David S. ; De Korte, Chris L. ; Aikawa, Masanori ; Airaksinen, K. E Juhani ; Assmann, Gerd ; Becker, Christoph R. ; Chesebro, James H. ; Farb, Andrew ; Galis, Zorina S. ; Jackson, Chris ; Jang, Ik Kyung ; Koenig, Wolfgang ; Lodder, Robert A. ; March, Keith ; Demirovic, Jasenka ; Navab, Mohamad ; Priori, Silvia G. ; Rekhter, Mark D. ; Bahr, Raymond ; Grundy, Scott M. ; Mehran, Roxana ; Colombo, Antonio ; Boerwinkle, Eric ; Ballantyne, Christie ; Insull, William ; Schwartz, Robert S. ; Vogel, Robert ; Serruys, Patrick W. ; Hansson, Goran K. ; Faxon, David P. ; Kaul, Sanjay ; Drexler, Helmut ; Greenland, Philip ; Muller, James E. ; Virmani, Renu ; Ridker, Paul M. ; Zipes, Douglas P. ; Shah, Prediman K. ; Willerson, James T. / From Vulnerable Plaque to Vulnerable Patient : A Call for New Definitions and Risk Assessment Strategies: Part II. In: Circulation. 2003 ; Vol. 108, No. 15. pp. 1772-1778.
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T1 - From Vulnerable Plaque to Vulnerable Patient

T2 - A Call for New Definitions and Risk Assessment Strategies: Part II

AU - Naghavi, Morteza

AU - Libby, Peter

AU - Falk, Erling

AU - Casscells, S. Ward

AU - Litovsky, Silvio

AU - Rumberger, John

AU - Badimon, Juan Jose

AU - Stefanadis, Christodoulos

AU - Moreno, Pedro

AU - Pasterkamp, Gerard

AU - Fayad, Zahi

AU - Stone, Peter H.

AU - Waxman, Sergio

AU - Raggi, Paolo

AU - Madjid, Mohammad

AU - Zarrabi, Alireza

AU - Burke, Allen

AU - Yuan, Chun

AU - Fitzgerald, Peter J.

AU - Siscovick, David S.

AU - De Korte, Chris L.

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AU - Airaksinen, K. E Juhani

AU - Assmann, Gerd

AU - Becker, Christoph R.

AU - Chesebro, James H.

AU - Farb, Andrew

AU - Galis, Zorina S.

AU - Jackson, Chris

AU - Jang, Ik Kyung

AU - Koenig, Wolfgang

AU - Lodder, Robert A.

AU - March, Keith

AU - Demirovic, Jasenka

AU - Navab, Mohamad

AU - Priori, Silvia G.

AU - Rekhter, Mark D.

AU - Bahr, Raymond

AU - Grundy, Scott M.

AU - Mehran, Roxana

AU - Colombo, Antonio

AU - Boerwinkle, Eric

AU - Ballantyne, Christie

AU - Insull, William

AU - Schwartz, Robert S.

AU - Vogel, Robert

AU - Serruys, Patrick W.

AU - Hansson, Goran K.

AU - Faxon, David P.

AU - Kaul, Sanjay

AU - Drexler, Helmut

AU - Greenland, Philip

AU - Muller, James E.

AU - Virmani, Renu

AU - Ridker, Paul M.

AU - Zipes, Douglas P.

AU - Shah, Prediman K.

AU - Willerson, James T.

PY - 2003/10/14

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KW - Death

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KW - Plaque

KW - Sudden

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