The relationship between cholesterol, plaque rupture, and plaque stabilization

The relationship between cholesterol and mortality from cardiovascular disease (CVD) is well established. However, it is not as well appreciated that the increased mortality associated with elevations in the serum cholesterol level is related to an increase in plaque rupture-related events: unstable angina, fatal and nonfatal myocardial infarction (MI), and sudden ischemic cardiac death. Lowering of serum cholesterol levels, whether through diet or medications, reduces mortality from CVD through an ill-defined process known as plaque stabilization. In this chapter we review the epidemiological data linking hyperlipidemia to cardiovascular events, the evidence supporting the efficacy of lipid lowering in reducing plaque rupture-related events in patients with and without established coronary artery disease (CAD) and finally, the proposed mechanisms by which lipid lowering may stabilize the vulnerable plaque.