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July 13, 1998

Atherosclerosis and the Immune System

Arch Intern Med. 1998;158(13):1395-1396. doi:10.1001/archinte.158.13.1395

TRADITIONAL RISK factors such as cigarette smoking, hypertension, dyslipidemia, diabetes mellitus, sedentary lifestyle, obesity, imbalance of the hemostatic/fibrinolytic system, and family history of premature coronary disease play an important role in the development and progression of atherosclerosis and in the predisposition for unstable angina, myocardial infarction, and stroke.1,2 It is also increasingly clear that modification of these risk factors, in particular smoking cessation, control of hypertension, and vigorous treatment of hyperlipidemia, can favorably alter the natural progression of coronary heart disease and cerebrovascular disease.3 At the same time, clinicians are often confronted with patients who suffer cardiovascular events in the apparent absence of predisposing factors. Furthermore, in even the most successful clinical trials, less than 50% of cardiovascular events are prevented in treatment groups. Thus, much of the variability of atherosclerosis and its manifestations remains unexplained.