From atherosclerosis to atherothrombosis : from a silent chronic pathology to an acute critical event

peer reviewedCardiovascular disease still represents, together with cancer, a major cause of morbidity and mortality. Atherosclerosis is a silent progressive process, which can start in early life and usually progresses with advancing age. Besides genetic predisposition, atherosclerosis is accelerated by the presence of several modifiable risk factors such as smoking, dyslipidaemia, arterial hypertension and diabetes mellitus. Asymptomatic atherosclerosis may lead to an acute event, mostly due to plaque rupture and secondary thrombosis. If the thrombus is occlusive, according to the artery where it occurs, the acute complication involves most often an acute coronary event or an ischaemic stroke. Major cardiovascular events (MACEs) represent the primary outcome in a majority of clinical trials. Some populations, as patients with type 2 diabetes, are especially prone to these complications due to atherothrombosis linked to subclinical accelerated atherosclerosis. In most cases, an emergency intervention is mandatory to avoid premature death or irreversible sequelae