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Tens of millions of Americans over age 40 have diseased arteries that may put them at significant risk of a heart attack. James Muller, a Boston cardiologist, is on a quest to develop a way to predict who among them is actually likely to have one. 数千万40岁以上的美国人有动脉病变，这让他们面临着巨大的心脏病发作的风险。波士顿心脏病学家詹姆斯?穆勒(James Muller)正在努力找出预测他们当中哪些人会实际发病的方法。
Dr. Muller and a company he founded, Infraredx Inc., have developed a tool that analyzes deposits of cholesterol called plaques that accumulate in the coronary arteries and are the telltale signature of the disease that causes heart attacks. Using a combination of ultrasound and infrared spectroscopy, the device takes as many as 30,000 readings of an artery's chemistry in two minutes. 穆勒博士及其创建的公司Infraredx Inc.设计出了一种工具，它可以分析在冠状动脉中沉积的胆固醇──斑块，它是导致心脏病发作的疾病的示警信号。该设备结合超声波与红外线光谱，可以在两分钟内进行多达30,000次动脉化学指标读数。
The result, Dr. Muller says, indicates whether the plaque is 'hot' and poised to burst and potentially cause a heart attack or whether it amounts to a stable plaque that is unlikely to cause trouble. Kelvin Ma for The Wall Street Journal穆勒博士拿着他公司的产品，该产品可以识别出心脏病发作风险。穆勒博士称，该结果可以显示出斑块是属于“活跃”且面临爆发并可能导致心脏病发作的斑块，还是属于不太可能导致心脏问题的稳定斑块。
If the test proves effective in detecting and stopping heart attacks before they occur, it could be an important advance in the battle against the world's leading killer. While doctors know plenty about what makes people susceptible to heart disease, they aren't very good at identifying in advance the one million Americans who suffer a heart attack each year. 如果事实证明该检测在心脏病发作前就能对其有效测定和预防，那么这将是对抗世界主要致死疾病的战役中的一个重要进步。尽管医生们对于导致人们易患心脏病的因素已经了解得很多，但他们并不能很好地事先确认每年哪100万美国人将发作心脏病。
But bringing Dr. Muller's idea to fruition has been an arduous journey. Technical hurdles plus evolving scientific debate over whether detecting such 'vulnerable' plaques would make much difference have slowed progress and blunted investor interest. 但让穆勒博士的想法开花结果还有很艰难的路要走。技术障碍加上对检测这种“脆弱”斑块是否有用的科学争论令这项技术进展缓慢，也消磨了投资者的兴趣。
Dr. Muller says 14 years and $125 million have been put into the effort so far. Lately the news has been good, but it could still take several more years to determine whether the device has a role in heart-attack prevention across a broad population. 穆勒博士称，迄今为止他已在这项技术上投入14年的时间和1.25亿美元。最近的进展不错，但可能仍需数年才能确定该设备能否起到在广泛人群中预防心脏病发作的作用。
'It's been a very long road, much longer than I thought,' says Dr. Muller, whose eclectic career includes co-founding an organization of U.S. and Russian doctors called the International Physicians for the Prevention of Nuclear War, which won the Nobel Peace Prize in 1985. 穆勒博士说，“这是一条很长的路，比我想的要长得多。”他的副业包括共同创建了一家叫国际防止核战争医生组织(International Physicians for the Prevention of Nuclear War)的美国与俄罗斯医生组织，该组织曾获得1985年诺贝尔和平奖。
Defusing the Bomb 拆除炸弹
After a decade of research in which he revealed how factors such as anger, stress, physical exertion and sexual activity serve as 'triggers' for heart attacks, Dr. Muller coined the term 'vulnerable atherosclerotic plaque' in a journal article in 1989. It describes certain fatty deposits harbored in coronary-artery walls that in response to such triggers and other forces are prone to rupture. When they do, they expose their 'lipid core' contents to the bloodstream, potentially provoking a clot that can cause a heart attack. 穆勒博士经过10年的研究，发现了愤怒、压力、体力消耗与性活动等因素如何“诱发”心脏病，并在1989年的一篇期刊论文中首先提出了“脆弱动脉粥样硬化斑块”的说法。它描述了在冠状动脉壁上沉积的某些易受这些诱因和其他因素激发而破裂的脂肪块。当它们破裂时，内部的“脂质核”将暴露在血液中，可能会形成诱发心脏病的血栓。
If such plaques could be identified and defused with treatment before they burst, many heart attacks could be prevented, Dr. Muller reasons. 视频：如何预防及应对心脏病如何预防心脏病?心脏病发作时有何症状?在等待救护人员时应该做些什么。请看《华尔街日报》Ron Winslow和Melinda Beck为您带来的详细报道。穆勒博士推论，如果能识别出这种斑块，并在它们破裂之前通过治疗消灭它们，许多心脏病便可得以预防。
The idea has attracted other approaches, ranging from genetic testing to implantable devices that might detect an impending heart attack, though none have yet proved effective. 在这种想法的启发下，人们提出了其他方法，从基因检测到可能检测出即将发作的心脏病的可植入设备，但没有一种方法被证实有效。
The Infraredx device grew out of a conversation Dr. Muller had with a spectroscopy expert in the late 1990s, who told him it would be 'a piece of cake' to find lipid-core plaques with the technology. They launched the company in 1998 with an initial investment of $600,000. At first, 'every time we tried something it worked,' Dr. Muller recalls. In tests on diseased aortas obtained from autopsies, the device effectively picked out plaques that were loaded with cholesterol versus more fibrotic deposits that were stable. Infraredx的设备灵感来自于20世纪90年代末穆勒博士与一位光谱学专家的谈话，那位专家告诉他，用该技术找出脂质核斑块“易如反掌”。他们在1998年创建了这家公司，初始投资额为600,000美元。穆勒博士回忆道，起初，“我们的每次尝试都成功了。”在对尸体解剖获得的病变主动脉进行检测时，该设备有效找出了富含胆固醇的斑块，而不是稳定的纤维性沉积物。
But to analyze plaque, the device has to be deployed on the end of a catheter inserted into an artery in the groin and snaked into the coronary arteries. Making it small enough to travel inside blood vessels and fast enough to quickly get readings proved daunting. In 2003, after spending several million dollars more on the project, the company was within days of closing before a couple of investors rescued it. 但为了分析斑块，该设备必须被放置在导管末端，插入腹股沟的动脉，并伸入冠状动脉。事实证明，要让设备小到足以在血管内移动，并移动得足够快以迅速获得读数是很困难的。2003年，在该项目上又花费了数百万美元后，该公司几近破产，直到几位投资者施以援手。