Identification and treatment of vulnerable plaque.

It is now well recognized that the rupture of vulnerable plaque, which consists of an atheromatous plaque core covered by a thin fibrous cap with ongoing inflammation, is a major cause of thrombus formation leading to the development of acute coronary syndrome. Several diagnostic techniques, including vascular imaging and serologic markers, are clinically available or currently under investigation for the detection of vulnerable plaque. A combination of several diagnostic modalities might allow effective screening of individuals at high risk for future cardiovascular events. Plaque stabilization with pharmacologic interventions--statins, beta-blockers, and angiotensin-converting enzyme inhibitors--might effectively prevent the development of acute coronary syndromes caused by plaque disruption.