Acute coronary syndromes: pathophysiology and preventive priorities.

Coronary atherosclerosis and its thrombotic complications are major causes of mortality and morbidity throughout the industrialized world. Atherosclerosis is a focal, pathological phenomenon characterized by the thickening and hardening of arteries due to accumulation of lipids, carbohydrates, blood products, fibrous tissue, and calcium deposits within the subendothelial space. Significant advances have been made in understanding the mechanisms underlying this disease process, and there is considerable evidence to show that plaque composition is a major determinant of the onset and severity of acute coronary syndromes. The ability to identify plaque composition and monitor its progression can, therefore, provide valuable information regarding the development of acute coronary syndromes and target areas for pharmacological intervention to reduce or prevent the socioeconomic impact of cardiovascular disease. This chapter will describe the pathogenesis of plaque formation and rupture and assess the role of thrombus and thrombosis in the progression of atherosclerotic disease. Furthermore, we shall briefly discuss therapeutic interventions and speculate on possible targets for future research.