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Circulating microparticle levels in patients with coronary artery disease: a new indicator of vulnerability?

Nicolas Amabile, Chantal M. Boulanger
DOI: http://dx.doi.org/10.1093/eurheartj/ehr055 1958-1960 First published online: 15 March 2011

This editorial refers to ‘Circulating CD31+/Annexin V+ microparticles correlate with cardiovascular outcomes’, by J.-M. Sinning et al., on page 2034

Despite significant advances in medical and interventional management during the past decades, coronary artery disease (CAD) and its consequences, which include myocardial infarction, sudden cardiac death, and chronic cardiac failure, remain a major contributor to mortality in western countries. Lifestyle modifications and secondary prevention medications, such as statins or angiotensin-converting enzyme (ACE) inhibitors, have improved outcome, but some patients still experience adverse cardiovascular events as a consequence of a particular atherosclerotic disease evolution. Identification of these high-risk, vulnerable patients remains a challenging issue.1 Atherosclerosis is a systemic disease characterized by endothelial dysfunction and by local and general inflammation. It is aggravated by platelet activation, and its ultimate evolution is plaque rupture and thrombosis.2 Identification of vulnerable plaques cannot be achieved by conventional angiography and requires sophisticated and invasive investigations such as intravascular ultrasound, optical coherence tomography, or magnetic resonance imaging.1 Moreover, there is no real consensus regarding a simple definition of vulnerable plaque. Risk stratification of patients based on measurement of circulating biomarkers [high sensitivity C-reactive protein, soluble lipoprotein phospholipase A2, B-type natriuretic peptide (BNP), etc.] or non-invasive evaluation of vascular structure or function (carotid intima-media thickness, flow-mediated dilation, etc.) appear to be more efficient tools in many respects.1 However, none of the above-cited parameters appears to be perfectly appropriate in view of the required criteria (sensitivity, specificity, …