TY - JOUR
T1 - The 'Perfect Storm' and Acute Coronary Syndrome Onset
T2 - Do psychosocial factors play a role?
AU - Burg, Matthew M.
AU - Edmondson, Donald
AU - Shimbo, Daichi
AU - Shaffer, Jonathan
AU - Kronish, Ian M.
AU - Whang, William
AU - Alcántara, Carmela
AU - Schwartz, Joseph E.
AU - Muntner, Paul
AU - Davidson, Karina W.
N1 - Funding Information:
This work was supported by grants HL-088117 , HL-101663 , HL-84034 , HL084438 , from the National Institutes of Health . The content is solely the responsibility of the author and does not necessarily represent the official views of the NIH.
PY - 2013/5
Y1 - 2013/5
N2 - The revolution in cardiac care over the past two decades, characterized by emergent revascularization, drug eluting stents, anti-platelet medications, and advanced imaging has had little impact on overall ACS recurrence, or ACS prevention. The "Perfect Storm" refers to a confluence of events and processes, including atherosclerotic plaque, coronary flow dynamics, hemostatic and fibrinolytic function, metabolic and inflammatory conditions, neurohormonal dysregulation, and environmental events that give rise to, and result in an ACS event. In this article we illustrate the limits of the traditional main effect research model, giving a brief description of the current state of knowledge regarding the development of atherosclerotic plaque and the rupturing of these plaques that defines an ACS event. We then apply the Perfect Storm conceptualization to describe a program of research concerning a psychosocial vulnerability factor that contributes to increased risk of recurrent ACS and early mortality, and that has defied our efforts to identify underlying pathophysiology and successfully mount efforts to fully mitigate this risk.
AB - The revolution in cardiac care over the past two decades, characterized by emergent revascularization, drug eluting stents, anti-platelet medications, and advanced imaging has had little impact on overall ACS recurrence, or ACS prevention. The "Perfect Storm" refers to a confluence of events and processes, including atherosclerotic plaque, coronary flow dynamics, hemostatic and fibrinolytic function, metabolic and inflammatory conditions, neurohormonal dysregulation, and environmental events that give rise to, and result in an ACS event. In this article we illustrate the limits of the traditional main effect research model, giving a brief description of the current state of knowledge regarding the development of atherosclerotic plaque and the rupturing of these plaques that defines an ACS event. We then apply the Perfect Storm conceptualization to describe a program of research concerning a psychosocial vulnerability factor that contributes to increased risk of recurrent ACS and early mortality, and that has defied our efforts to identify underlying pathophysiology and successfully mount efforts to fully mitigate this risk.
KW - Acute coronary syndrome
KW - Depression
KW - Stress
UR - http://www.scopus.com/inward/record.url?scp=84876878264&partnerID=8YFLogxK
U2 - 10.1016/j.pcad.2013.03.003
DO - 10.1016/j.pcad.2013.03.003
M3 - Article
C2 - 23621970
AN - SCOPUS:84876878264
SN - 0033-0620
VL - 55
SP - 601
EP - 610
JO - Progress in Cardiovascular Diseases
JF - Progress in Cardiovascular Diseases
IS - 6
ER -