New roles for antiplatelet agents in treatment of atherothrombotic diseases.

www.japha.org March/April 2004 Vol. 44, No. 2, Suppl. 1 Investigations over recent years into the pathophysiology of atherosclerosis and atherothrombosis have significantly broadened our understanding of the mechanisms underlying these disease processes. Currently, atherogenesis is viewed as a diffuse inflammatory process that affects largeand mediumdiameter vessels throughout the arterial tree. By causing partial or total occlusion of affected arteries, atherothrombosis—the process of plateletrich thrombus formation at sites of atherosclerotic plaque disruption—can be considered the common pathophysiologic mechanism responsible for the various clinical manifestations of vascular ischemia, such as ischemic stroke and acute coronary syndromes (unstable angina and Q-wave and non–Q-wave myocardial infarction). Progression of plaque may also occur as an effect of the sequence initiated by atherothrombosis. Accordingly, ischemic coronary, cerebrovascular, and peripheral arterial disease— conditions historically regarded as discrete entities—are now increasingly regarded as different facets of the same systemic disease process. Treatment of atherosclerotic disease should include management of cardiovascular risk factors with the aim of preventing further plaque progression, and subsequent clinical events, and the use of anticoagulants and antiplatelet drugs to prevent atherothrombosis. An important consequence of the generalized nature of atherothrombosis is that after experiencing an ischemic event in one arterial bed, the patient is at risk of subsequent ischemic events in arterial beds that are seemingly unaffected and initially asymptomatic. Secondary prevention of an ischemic event in the original arterial bed will provide primary prevention against potential future ischemic events in other arterial beds. Based on this unified paradigm of the factors leading to the development of atherothrombotic disease, the theme of the review articles included in this supplement is how best to manage patients with atherothrombotic disease for optimal outcome, particularly with regard to the increasing role of antiplatelet therapy in light of recent randomized clinical trials. The availability of these and other treatment options is likely to produce more effective and individualized strategies for management of patients with atherothrombosis. These indepth reviews provide a comprehensive foundation for understanding the current status of treatment strategies in atherothrombosis, and a sense of the evolving therapeutic strategies that can be anticipated within the next few years. As such, this supplement provides important information that will have practical implications for the pharmacist. The National Pharmacy Cardiovascular Council (NPCC), sponsor of this supplement, comprises academic and clinical pharmacy practitioners dedicated to improving the cardiovascular health of all people and to enhancing the pharmacist’s involvement in the management of patients with dyslipidemia, hypertension, diabetes, and other cardiovascular and related conditions. NPCC conducts workshops, symposia, and training programs for pharmacists and contributes to the pharmacy literature articles, monographs, and handbooks on the pathophysiology and treatment of cardiovascular disorders.