Author + information
- Received July 19, 1993
- Revision received October 21, 1993
- Accepted October 25, 1993
- Published online March 1, 1994.
- James E. Muller, MD, FACC∗,
- George S. Abela, MD, FACC,
- Richard W. Nesto, MD, FACC and
- Geoffrey H. Tofler, MD, FACC
- ↵∗Address for correspondence: Dr. James E. Muller, Institute for Prevention of Cardiovascular Disease, Deaconess Hospital, Harvard Medical School, 1 Autumn Street, 5th Floor, Boston, Massachusetts 02215.
A neglected area of cardiovascular research—study of the mechanisms of acute disease onset—is receiving increased attention. The new interest is based on the undisputed findings that onset of myocardial infarction and sudden cardiac death are more likely soon after awakening, indicating that activities of the patient frequently trigger the diseases. Triggering may occur when stressors produce hemodynamic, vasoconstrictive and prothrombotic forces—acute risk factors—that, in the presence of a vulnerable atherosclerotic plaque, cause plaque disruption and thrombosis. Triggering research may clarify mechanisms and suggest measures to sever the linkage between a potential trigger and its pathologic consequence.
- Received July 19, 1993.
- Revision received October 21, 1993.
- Accepted October 25, 1993.