Triggering of Acute Coronary Syndromes

1. Front Matter

   Pages i-xx

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2. Epidemiology

   1. Magnitude of cardiovascular disease: impact and prevention in populations

      • Diane E. Bild, Lawrence Friedman

      Pages 1-13

   2. Secular trends and declining mortality rates from coronary heart disease in the United States

      • Robert J. Goldberg

      Pages 15-35

   3. Circadian variation in the incidence of transient myocardial ischemia

      • David Mulcahy, Henry Purcell

      Pages 37-51

   4. Circadian variation in the onset of myocardial infarction and sudden cardiac death

      • James E. Muller, Stefan N. Willich

      Pages 53-70

   5. Triggering of myocardial infarction by physical activity, emotional stress and sexual activity

      • Murray A. Mittleman

      Pages 71-80

   6. Physical activity, time of awakening, and other possible triggers of sudden cardiac death

      • Stefan N. Willich, Hans-Richard Arntz

      Pages 81-93

   7. Subacute psychobiological factors predisposing to triggering of coronary syndromes

      • Sylvia Wassertheil-Smoller

      Pages 95-110

3. Physiology

   1. The genetic contribution to the onset of acute coronary heart disease

      • François Cambien, Odette Poirier, Alun Evans, Dominique Arveiler, Gérald Luc, Jean-Pierre Cambou et al.

      Pages 111-133

   2. Hemostatic risk factors for cardiovascular disease

      • Praveen P. Jadhav, Geoffrey H. Tofler

      Pages 135-151

   3. The imbalance of coagulation and fibrinolysis in coronary heart disease and its relation to traditional risk factors

      • Kaj Winther, Steen Elkjær Husted, Hans Kræmmer Nielsen, Jørn Dalsgaard Nielsen

      Pages 153-173

   4. Mechanisms contributing to the abrupt conversion from stable to unstable angina and myocardial infarction

      • James T. Willerson

      Pages 175-184

   5. Circadian fluctuation of fibrinolytic factors in blood

      • Felicita Andreotti, Alessandro Manzoli

      Pages 185-199

   6. The role of thrombosis in acute coronary heart disease

      • Antonio Fernández-Ortiz, Valentín Fuster

      Pages 201-218

   7. The role of coronary vasomotor tone in coronary artery disease

      • Arshed A. Quyyumi

      Pages 219-236

4. Pathology

   1. Models of the intracoronary pathogenesis of acute coronary heart disease

      • Joseph P. Jiang, Charles L. Feldman, Peter H. Stone

      Pages 237-257

   2. Some thoughts on the causes of coronary thrombosis in atherosclerotic arteries and the research necessary for their future exploration

      • Paris Constantinides

      Pages 259-265

   3. Determinants of rupture of atherosclerotic coronary lesions

      • Pedro R. Moreno, Prediman K. Shah, Erling Falk

      Pages 267-283

5. Prevention

   1. Primary prevention of triggering of coronary heart disease

      • Ira S. Ockene

      Pages 285-293

   2. Chronopharmacological aspects of coronary heart disease

      • Björn Lemmer, Klaus Witte

      Pages 295-308

Cardiovascular diseases account for about half of total mortality in industrialised societies. This figure has declined only slightly and in few countries over the past few decades, which is disturbing in view of our increasing insight into long-term risk factors of coronary heart disease and the dramatic improvement in the acute therapy of its manifestations. One important reason for this is the high fatality during the initial hours of a coronary event, i.e. before medical treatment can be provided. Approximately one quarter of all patients suffering an acute cardiac event die prior to admission to hospital.
As a result, the focus of current research has shifted from after-the-fact therapy to the triggering phase of acute coronary disease. Epidemiological observations of recent trends and newly identified determinants of coronary disease and the results of substantial pathophysiological studies of the conversion from chronic coronary disease to an acute event provide the basis for new hypotheses about the triggering mechanisms. The ultimate goal is to design more effective preventive strategies for these deadly diseases.
The present extensive summary of important scientific and clinical developments in the study of the triggering and prevention of coronary syndromes that have been seen over the last ten years contains the contributions of leading experts in the field. It presents a cooperative, balanced view derived from physicians and researchers in the U.S. and Europe.

• cardiovascular
• coronary artery disease
• electrophysiology
• gene therapy
• heart
• sudden cardiac death
• vascular disease

` ... concise and well written. References are up-to-date. ... can be recommended to all clinicians involved in the care of the acute coronary patient.'
Cardiologie, 3 (1996)

• Institute for Epidemiology, Social and Preventive Medicine, Humboldt University of Berlin, Klinikum Charité, Berlin, Germany

  Stefan N. Willich

• Institute for Prevention of Cardiovascular Disease, Deaconess Hospital, Harvard Medical School, Boston, USA

  James E. Muller

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