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May 21, 2026Journal of the American College of Cardiology

Mechanisms of plaque vulnerability and rupture

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Key result

Risk-factor reduction may mitigate rupture and thrombosis in vulnerable atherosclerotic plaques.

Design

Review

Authors

PSPrediman K. ShahPreventive Cardiology

Discussion

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Implication

Understanding the mechanisms of plaque vulnerability highlights the importance of reducing lipid content and inflammation to prevent acute ischemic events.

Key Points

  • To delineate the histomorphologic, cellular, and enzymatic mechanisms responsible for atherosclerotic plaque vulnerability, rupture, and subsequent acute ischemic events.
  • Synthesized findings on coronary artery plaque morphology, luminal stenosis, and vascular remodeling patterns.
  • Analyzed biochemical pathways driving extracellular matrix breakdown, including matrix-degrading proteinases and inflammatory cytokine activity.
  • Vulnerable plaques frequently cause only mild luminal stenosis and exhibit outward remodeling, making them prone to underestimation on angiography despite causing most clinical ruptures.
  • Thinning of the protective fibrous cap is driven by enzyme-mediated matrix depletion, smooth muscle cell loss, neovascularization, and interferon-gamma release from activated T cells.
  • Therapeutic reduction of lipid burden and plaque inflammation strengthens cap stability, mitigating the risk of acute thrombotic occlusion.

PICO

P
Population
Atherosclerotic plaque vulnerability and rupture

Understanding the mechanisms of plaque vulnerability highlights the importance of reducing lipid content and inflammation to prevent acute ischemic events.

Cite This Study

Prediman K. Shah (2003) conducted a review in Atherosclerotic plaque vulnerability and rupture. Vulnerable atherosclerotic plaques, characterized by high lipid content and inflammation, are prone to rupture and thrombosis, which may be mitigated by risk-factor reduction.

synapsesocial.com/papers/6a0f76cd91e834c62cd8a5cchttps://doi.org/10.1016/s0735-1097(02)02834-6
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