Temporal trends for the global coronary epidemic vary by region but in most developed countries mortality is in decline.1 Life style adjustments have contributed to this decline, most recently the implementation of comprehensive smoke-free legislation in many countries that has already caused significant reductions in acute coronary events.2 Smoking, a potent thrombogenic stimulus, is a major d...

© 2009 Mayo Foundation for Medical Education and Research The term acute coronary syndrome (ACS) refers to any group of clinical symptoms compatible with acute myocardial ischemia and covers the spectrum of clinical conditions ranging from unstable angina (UA) to non– ST-segment elevation myocardial infarction (NSTEMI) to ST-segment elevation myocardial infarction (STEMI). Unstable angina and N...

Changes in the definition of terms relating to the diagnosis of myocardial infarction (MI) have evolved by better understanding of the pathophysiology culminating in the new term of acute coronary syndrome (ACS). Figure 1 illustrates the processes that occur in the development of an acute coronary event. The coronary arteries become stenosedwith age by the deposition of lipid-rich atheroma in t...

Ambient air pollution has been linked to exacerbation of cardiovascular disease morbidity and mortality. 1 These associations have been strikingly robust and range from the observation of coronary heart disease exacerbation within hours of exposure to an increased risk of ischaemic heart disease mortality for subjects chronically exposed to elevated concentrations of ambient particles. Two main...

Ischemic heart disease includes a wide spectrum of conditions, ranging from silent ischemia and exertion-induced angina, through unstable angina, to acute MI. Unstable angina occupies the center of this spectrum, causing disability and risk greater than that of chronic stable angina but less than that of acute MI (Fig 1). Although non–Q-wave MI for many years was considered prognostically simil...

Lipoproteins represent major risk factors, both positive and negative, for atherosclerotic cardiovascular disease. The major plasma lipid traits, low-density lipoprotein cholesterol (LDL-C), triglycerides, and high-density lipoprotein cholesterol (HDL-C) are all predictive of cardiovascular risk and have been considered targets for therapeutic intervention. Here, we specifically consider the ro...