Basic science concepts

Therapeutic options for atherosclerosis have expanded enormously over the past three decades. In particular, the development of surgical and percutaneous revascularization strategies for treating focal coronary lesions has effectively reduced morbidity and (to a lesser extent) mortality for a large number of patients. Greater attention is now being focused on a significant minority of patients with coronary arteriosclerosis who have significant but diffuse disease which is not amenable to mechanical revascularization. Even with optimal medical treatment, morbidity, mortality, and associated costs in this group remain high. Considerable hope has been vested in strategies which seek to augment the endogenous neovascularization response to ischemia. Although early clinical trials of a number of agents have been disappointing, continuing advances in our understanding of the mechanisms and key molecular pathways involved suggest we can remain optimistic that this approach will ultimately be successful.