Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece.
Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
Atherosclerosis. 2024 Aug;395:117579. doi: 10.1016/j.atherosclerosis.2024.117579. Epub 2024 May 15.
Atherosclerotic cardiovascular disease (ASCVD) remains a leading cause of morbidity and mortality worldwide, highlighting the urgent need for advancements in risk assessment and management strategies. Although significant progress has been made recently, identifying and managing apparently healthy individuals at a higher risk of developing atherosclerosis and those with subclinical atherosclerosis still poses significant challenges. Traditional risk assessment tools have limitations in accurately predicting future events and fail to encompass the complexity of the atherosclerosis trajectory. In this review, we describe novel approaches in biomarkers, genetics, advanced imaging techniques, and artificial intelligence that have emerged to address this gap. Moreover, polygenic risk scores and imaging modalities such as coronary artery calcium scoring, and coronary computed tomography angiography offer promising avenues for enhancing primary cardiovascular risk stratification and personalised intervention strategies. On the other hand, interventions aiming against atherosclerosis development or promoting plaque regression have gained attention in primary ASCVD prevention. Therefore, the potential role of drugs like statins, ezetimibe, proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, omega-3 fatty acids, antihypertensive agents, as well as glucose-lowering and anti-inflammatory drugs are also discussed. Since findings regarding the efficacy of these interventions vary, further research is still required to elucidate their mechanisms of action, optimize treatment regimens, and determine their long-term effects on ASCVD outcomes. In conclusion, advancements in strategies addressing atherosclerosis prevention and plaque regression present promising avenues for enhancing primary ASCVD prevention through personalised approaches tailored to individual risk profiles. Nevertheless, ongoing research efforts are imperative to refine these strategies further and maximise their effectiveness in safeguarding cardiovascular health.
动脉粥样硬化性心血管疾病（ASCVD）仍然是全球发病率和死亡率的主要原因，突出表明需要在风险评估和管理策略方面取得进展。尽管最近取得了重大进展，但识别和管理表面健康但有更高动脉粥样硬化风险的个体以及有亚临床动脉粥样硬化的个体仍然面临重大挑战。传统的风险评估工具在准确预测未来事件方面存在局限性，并且无法涵盖动脉粥样硬化轨迹的复杂性。在这篇综述中，我们描述了新兴的生物标志物、遗传学、先进成像技术和人工智能方法，以解决这一差距。此外，多基因风险评分和成像方式，如冠状动脉钙评分和冠状动脉计算机断层血管造影，为增强主要心血管风险分层和个性化干预策略提供了有前途的途径。另一方面，针对动脉粥样硬化发展或促进斑块消退的干预措施在原发性 ASCVD 预防中受到关注。因此，还讨论了他汀类药物、依折麦布、前蛋白转化酶枯草溶菌素/凝血酶 9（PCSK9）抑制剂、ω-3 脂肪酸、抗高血压药物以及降血糖和抗炎药物等药物的潜在作用。由于这些干预措施的疗效存在差异，因此仍需要进一步研究以阐明其作用机制、优化治疗方案，并确定它们对 ASCVD 结局的长期影响。总之，针对动脉粥样硬化预防和斑块消退的策略的进展为通过针对个体风险概况的个性化方法增强原发性 ASCVD 预防提供了有前途的途径。然而，持续的研究努力对于进一步完善这些策略并最大限度地提高它们在保护心血管健康方面的效果至关重要。
