Intraplaque haemorrhages as the trigger of plaque vulnerability.
Intraplaque haemorrhages as the trigger of plaque vulnerability.
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DOI：
10.1093/eurheartj/ehr054
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发表时间：
2011-08
影响因子：
39.3
通讯作者：
Pasterkamp G
中科院分区：
文献类型：
--
作者：
Michel JB;Virmani R;Arbustini E;Pasterkamp G
斑块内出血对斑块生物学和稳定性的有害影响的宏观观点和示意图。动脉粥样硬化血栓仍然是西方国家发病率和死亡率的主要原因之一。人类动脉粥样硬化性血栓疾病在生命早期开始，与血管内壁的循环脂质滞留有关。危险因素：血脂异常、糖尿病、吸烟、高血压、衰老等促进临床表现的进展。从最初的动脉壁脂质滞留到临床事件的演变是一个日益复杂的生物过程的连续体。目前防治动脉粥样硬化血栓形成后果的战略要么侧重于促进健康的生活方式和对危险因素的预防性治疗，要么侧重于晚期干预战略。尽管有这些治疗手段，但临床事件的发生率仍然非常高，至少在一定程度上取决于2型糖尿病和老龄化的日益频繁。但是，一些仅关注预防代谢风险的医学治疗未能降低心血管死亡率，从而说明我们对人类动脉粥样硬化血栓形成导致临床事件的病理生理学的理解仍然不完整。新的范例正在出现，这可能会产生新的实验策略，以提高治疗效果和预测疾病进展。最近的研究加强了斑块内新生血管和出血的概念（图1，上表）是在斑块进展和白细胞浸润中起主要作用的事件，也可以作为未来事件发展的风险指标。我们对斑块内出血作为引发急性临床事件的关键事件的理解的最新进展对临床研究和可能的未来临床实践具有重要意义。
Macroscopic view and schematic representation of the detrimental consequences of intraplaque haemorrhages on plaque biology and stability. Atherothrombosis remains one of the main causes of morbidity and mortality in the western countries. Human atherothrombotic disease begins early in life in relation to circulating lipid retention in the inner vascular wall. Risk factors enhance the progression towards clinical expression: dyslipidaemia, diabetes, smoking, hypertension, ageing, etc. The evolution from the initial lipid retention in the arterial wall to clinical events is a continuum of increasingly complex biological processes. Current strategies to fight the consequences of atherothrombosis are orientated either towards the promotion of a healthy life style and preventive treatment of risk factors, or towards late interventional strategies. Despite this therapeutic arsenal, the incidence of clinical events remains dramatically high, dependent, at least in part, on the increasing frequency of type 2 diabetes and ageing. But some medical treatments, focusing only on prevention of the metabolic risk, have failed to reduce cardiovascular mortality, thus illustrating that our understanding of the pathophysiology of human atherothrombosis leading to clinical events remain incomplete. New paradigms are now emerging which may give rise to novel experimental strategies to improve therapeutic efficacy and prediction of disease progression. Recent studies strengthen the concept that the intraplaque neovascularization and bleeding (Figure 1, upper panel) are events that could play a major role in plaque progression and leucocyte infiltration, and may also serve as a measure of risk for the development of future events. The recent advances in our understanding of IntraPlaque Hemorrhage as a critical event in triggering acute clinical events have important implications for clinical research and possibly future clinical practice.
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影响因子：
5.3
作者：
Derksen, Wouter J. M.;Peeters, Wouter;Vink, Aryan
通讯作者：
Vink, Aryan
影响因子：
56.9
作者：
CHANDLER, AB;HAND, RA
通讯作者：
HAND, RA
影响因子：
6
作者：
Boyle, Joseph J.;Harrington, Heather A.;Haskard, Dorian O.
通讯作者：
Haskard, Dorian O.
影响因子：
29
作者：
Bouhlel, M. Amine;Derudas, Bruno;Chinetti-Gbaguidi, Giulia
通讯作者：
Chinetti-Gbaguidi, Giulia
影响因子：
4.3
作者：
AMMAR, AD;ERNST, RL;TRAVERS, H
通讯作者：
TRAVERS, H