The Attack on Coronary Disease: Should it be before, during or after?

The whole idea of primary prevention of arterial disease stems from the Framingham philosophy (Framingham Heart Study, 1948), which is based on an epidemiological approach. There is no doubt that this is has been successful in leading to a great reduction in smoking, correlating with a great reduction in coronary disease.

 One might consider the possibility of attacking the late phase of the thrombotic process rather than the initiation. The most popular idea about that is a plaque rupture leaking material that causes platelet activation and adhesion. However, in our practice coronary angiography showed that approximately only half the culprit lesions were eccentric, and half concentric. Concentric lesions are not likely to respond to statin, and that may explain why non-ST elevation acute coronary syndromes have outnumbered ST elevation infarcts in frequency since 2000. Read more>>>>>>>>>>>