From Antonopoulos AS, et al. Sci Transl Med. 2017;9.

Vulnerable Plaque: Are Targeted Therapies Within Reach?

MedScape: Rupture of unstable nonobstructive plaque is the underlying cause of most acute coronary syndromes.[1,2] However, imaging tests to identify high-risk plaque features such as thin-cap fibroatheroma (TCFA) or spotty calcification are not practical for everyday use and have had mixed success for predicting future events. […] Two recent studies aim to bring vulnerable plaque identification into the cath lab routine, and trials of targeted therapies are ongoing. At the 2018 European Society of Cardiology, the CRISP-CT study used the perivascular fat attenuation index (FAI)—a measure of coronary inflammation—to predict events in nearly 4000 patients undergoing CT angiography. Perivascular FAI represents the first noninvasive assessment of coronary inflammation; high values were associated with increased cardiac mortality (cut-off ≥–70.1 Hounsfield units). Stephan Achenbach, MD (Friedrich-Alexander-University, Erlangen, Bavaria, Germany), who was involved in CRISP-CT, views it as a change in thinking: “The old theory is that the fat influences the plaque. Now the Oxford researchers have turned this around, it’s the plaque influencing the fat,” he said in an interview….

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