Coronary atherosclerosis begins with the impairment of endothelial function of anti-thrombosis, vasorelaxation, anti-proliferation, and anti-atherosclerosis. Endothelial dysfuction is induced not only by bio-chemical factors such as
hypercholesterolemia, smoking, hypertension, and diabetes mellitus, but also by bio-mechanical factors, such as disturbance of laminar flow of blood stream. In addition to these conventional risk factors, new ones emerge as important factors for
atherosclerosis, which include hyperhomocysteinemia, oxidative stress, and infectious agents. The results of the several ongoing trials of antibiotics, antioxidant, and vitamins for prevention of cardiovascular diseases will elucidate
implications
of
these new risk factors for coronary atherosclerosis.
The new insight on the pathogenesis of coronary atherosclerosis will change the preventive measures against cardiovascular events. We have to pay attention not only to the conventional measures such as reducing the cholesterol level, correcting
hypertension, and prescribing anti-platelet agents, but also to the new measures such as reducing the homocysteine level by folate and vitamin B, encouraging intake of antioxidant in fresh vegetables and nuts, and eradicating infectious agents by
oral
care and ulcer treatment.
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