ABSTRACT
Cardiovascular disease affects approximately 60 million people in the United States. Using available tests including coronary risk factors, coronary artery calcium scores, biomarkers, and noninvasive stress testing can only identify asymptomatic patients with yearly mortality of 5%. Advances in molecular biology and structural information provided from human autopsy studies from patients dying with vulnerable and ruptured atherosclerotic plaque have given information on plaque evolution, plaque composition, and revealed potential targets for imaging. American Heart Association classification of atherosclerotic lesions were modified and simplified by R. Virmani et al. based on morphology. Early lesions are characterized by endothelial injury and attractions of circulating monocytes via chemotactic substances such as monocyte chemoattractant protein-1 (MCP-1) that is produced by injured endothelial and smooth muscle cells as well as activated monocytes/macrophages. Receptors to MCP-1 are upregulated on monocytes and these receptors attract the cells to migrate to endovascular sites of injury.
