Circulation. 1998;97:2382-2383
(Circulation. 1998;97:2382-2383.)
© 1998 American Heart Association, Inc.
Reactive Oxygen Species, Metalloproteinases, and Plaque Stability
M.J. Davies, MD, FRCP, FRCPath, FACC
From St George's Hospital Medical School, Histopathology
Department, London, UK.
Correspondence to M.J. Davies, MD, FRCP, FRCPath, FACC, St George's Hospital Medical School, BHF Cardiovascular Pathology Unit, Histopathology Department, Cranmer Terrace, London SW17 ORE, UK.
Key Words: Editorials • metalloproteinases • free radicals
Understanding
of the factors that lead to atherosclerotic plaque instability causing
thrombosis is increasing rapidly. The morphological characteristics of
plaques that are unstable, ie, complicated by recent thrombosis, lend
insight into the structural and cellular features of presently
stable plaques that are vulnerable, ie, at high risk of becoming
unstable in the future. The risk of any individual with
coronary atherosclerosis developing an acute
ischemic event depends on the number of such vulnerable plaques
present in that individual rather than the number of plaques
overall. One factor in the variation in risk for a further acute event
after, for example, an acute myocardial infarction is the variation
from individual to individual in the number of vulnerable plaques.
The features found in unstable plaques compared with stable
plaques have been shown by study of both necropsy and atherectomy
material to be a large core of extracellular lipid, a high density of
macrophages containing lipid, a reduced smooth muscle content,
and a thin cap.1 2 The majority of episodes of
major thrombi, particularly in white men with high plasma lipids, are
due to plaque rupture.3 4 In plaque rupture, the
fibrous cap of a plaque tears, exposing the highly thrombogenic lipid
core to blood in the lumen of the artery. The mechanical strength of
the plaque cap is therefore a vital component of plaque stability and
depends on the amount and organization of collagen and other connective
tissue proteins. Smooth muscle cells exist in lacunae in the plaque
cap, where they produce and maintain . . . [Full Text of this Article]
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