Impact of risk factor modification on the CHD process

Advances in technology have allowed better characterization of the atherosclerotic process and the plaques most likely to rupture and lead to thrombus formation. It has been established that the plaques most likely to rupture are those that are fat-filled with a thin fibrous cap. Modification of risk factors by lowering cholesterol appears to stabilize atherosclerotic plaques by decreasing the content of fat, causing the cholesterol to crystallize and the fibrous cap to thicken. Macrophages are involved in plaque rupture and thrombus formation, and cholesterol lowering with a statin appears to prevent macrophages from entering the vessel wall and taking part in rupture and thrombus formation. High technology enables understanding plaque rupture and thrombus formation, but physicians need to apply this knowledge by implementing risk factor modification in the clinical setting.