Summary
The term ‘vulnerable plaque’ is used to refer to the lesions that are prone to rupture
and may cause life-threatening events like acute coronary syndrome or stroke.The study
of the vulnerable plaque phenotype and its detection has attracted increasing interest
over the past decades. During this time, there have been some remarkable transitions
in the paradigm on methods to identify patients at risk or patients to treat.Whereas
formerly, the key factors used to determine an individual’s risk were primarily population-based
traditional risk factors such as age, sex, body mass index, hypertension etc., new
approaches are based on conditional risk factors that represent an individual’s current
risk of suffering a cardiovascular event.These population based risk factors fall
short in predicting near-future events in a high-risk individual. In the early 2000s,
the focus of research into surrogate markers for cardiovascular event prediction shifted
from the vulnerable plaque to the identification of the vulnerable patient.This new
paradigm stimulated a number of new initiatives that aimed to identify vulnerable
patients by testing systemic biomarkers that could identify patients at high risk
for cardiovascular events. A second research paradigm is refocusing on the plaque
by searching for plaque-derived biomarkers and non-invasive imaging modalities to
assess characteristics of a plaque that determine its vulnerability.Although both
concepts are attractive, they still need proper validation in large multicenter cohorts,
while cost-effectiveness arguments also need to be assessed.
Keywords Cardiovascular event prediction - imaging - risk factors - biomarkers - atherosclerosis
