Plaque passivation: role of statins in acute coronary syndromes.

The past decade has witnessed revolutionary changes in the understanding of the pathogenesis and management of acute coronary syndromes (ACS). The major cause of ACS is the rupture or erosion of an atherosclerotic plaque and subsequent thrombosis leading to variable obstruction in the coronary arterial lumen. Clinical strategies for the management of ACS now focus more on creating plaque stability. The culprit plaque is akin to an active volcano that must be made quiescent. “Plaque passivation” is a therapeutic concept by which either the structure or the content of the vulnerable and active atherosclerotic plaque is modified to reduce the risk of subsequent rupture and thrombosis. To better understand the concept of plaque passivation, it is pertinent to understand the composition of vulnerable plaque, and the complex factors involved in its destabilization and rupture.