A Brief Note On Coronary Artery Disease Prevention

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Coronary artery bypasses surgery, percutaneous angioplasty-stent, aspirin use, cholesterol-lowering therapies, and increased awareness of coronary artery disease prevention are the main strategies for the preventive treatment of SCD [166]. As the main etiology behind coronary artery ischemia is the plaque rupture, methods to prevent plaque rupture, plaque stabilization, decreasing plaque formation and searching risk markers for sudden plaque rupture should be discovered. The role of cholesterol in SCD have been studied in many studies and there are both kind of results, some suggesting its significant role [39, 167] while other without any significant role [83].Low density lipoprotein (LDL) plays a significant role in atheroma formation…show more content…
This different expression of cell cycle regulatory proteins may be responsible for apoptosis of vascular smooth muscle cell and plaque destabilization [171]. Rao et al studied the mechanism of plaque rupture in carotids and proposed the mechanism by which EGFR activation induced MMP-1 and MMP-9 decreases the interstitial collagen causing plaque instability and increased vulnerability of plaque rupture, paving a future direction for translational approach of this concept for the prevention of myocardial infarction. It was also proposed that for plaque stabilization, selective blockade of EGFR and MMP-9 may be a promising strategy [172]. Identification of specific markers indicating a plaque prone to rupture and risk predictors for plaque rupture is an interesting area for further research. Currently we are working on the role of HMGB-1, RAGE, ENRAGE, TLR-4, TREM-1, TREM-2, MMP-1 and MMP-9 in plaque stability and destabilization in carotid artery. Acute unstable arrhythmias should be treated with external defibrillator according to ACLS algorithm and it has been suggested that biphasic waveform defibrillation is more effective than monophasic defibrillation[173]. Treating the patient’s arrhythmia in hospital is a secondary prevention but as the proportion of out of hospital death is more, there is a need to focus on primary prevention
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