A 44-Year-Old Man Is Evaluated in the Clinic for Occasional

A 44-year-old man is evaluated in the clinic for occasional chest discomfort that is not consistently related to exertion.  The patient's past medical history is significant for hypertension and hyperlipidemia.  His grandfather experienced a myocardial infarction at age 50.  Coronary CT angiography reveals several nonobstructive atherosclerotic plaques in the coronary arteries.  One plaque in the proximal left anterior descending artery appears extensive, has a large hypodense core, and occupies 40% of the lumen.  No intervention is performed.  One year later, the patient comes to the emergency department with acute severe chest pain and is found to have thrombotic occlusion of the proximal left anterior descending artery.  High intraplaque activity of which of the following enzymes most likely resulted in this patient's myocardial infarction?

A) Hydroxymethylglutaryl CoA reductase
B) Lysyl oxidase
C) Metalloproteinases
D) Procollagen peptidases
E) Prolyl hydroxylase

Correct Answer:

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