Department of Medicine, University of Central Florida College of Medicine, Orlando, FL, USA.
Division of Endocrinology, Diabetes, and Metabolism, School of Medicine, University of South Carolina, Columbia, SC, USA.
Expert Rev Cardiovasc Ther. 2022 Jul;20(7):515-527. doi: 10.1080/14779072.2022.2094771. Epub 2022 Jul 8.
Atherosclerosis can be considered a chronic inflammatory process that stands out as a dominant cause of cardiovascular disease (CVD). Since blood lipids are the leading risk factor for atherosclerosis development, lowering low-density lipoprotein cholesterol (LDL-C) and other apolipoprotein B-containing lipoproteins reduces the risk of future cardiovascular events. However, there has been significant progress in developing lipid-lowering drugs for aggressive management of dyslipidemia, the rates of CVD events remain unacceptably high, so there is great need to identify novel therapeutic pathways targeting the atherosclerosis process.
We discussed the current guidelines on CVD prevention, the role of novel lipid-lowering drugs, as well as emerging drugs for atherosclerosis, emphasizing the current data on compounds targeting inflammatory and oxidant pathways.
Although novel lipid-lowering drugs all showed their therapeutic efficacy in LDL-C lowering, data regarding their impact on cardiovascular outcomes is still inconclusive. On the other hand, some of the agents targeting inflammatory pathways, especially colchicine, showed promising results in terms of reducing CVD events. In contrast, those pointed at oxidant pathways failed to do so. Finally, exploring ways of targeting new therapeutic venues, such as adaptive immunity and clonal hematopoiesis, is a goal in the future.
动脉粥样硬化可以被视为一种慢性炎症过程，是心血管疾病（CVD）的主要病因。由于血液脂质是动脉粥样硬化发展的主要风险因素，降低低密度脂蛋白胆固醇（LDL-C）和其他载脂蛋白 B 脂蛋白可以降低未来心血管事件的风险。然而，在开发降脂药物以积极控制血脂异常方面已经取得了重大进展，但 CVD 事件的发生率仍然高得令人无法接受，因此非常有必要确定针对动脉粥样硬化过程的新的治疗途径。
我们讨论了 CVD 预防的现行指南、新型降脂药物的作用以及新兴的动脉粥样硬化药物，强调了针对炎症和氧化途径的化合物的现有数据。
虽然新型降脂药物在降低 LDL-C 方面均显示出治疗效果，但关于它们对心血管结局的影响的数据仍不确定。另一方面，一些针对炎症途径的药物，特别是秋水仙碱，在降低 CVD 事件方面显示出了有希望的结果。相比之下，针对氧化途径的药物则没有。最后，探索针对新的治疗靶点的方法，如适应性免疫和克隆性造血，是未来的一个目标。
