Bryniarski Krzysztof L, den Dekker Wijnand, Legutko Jacek, Gasior Pawel, Tahon Jeroen, Diletti Roberto, Wilschut Jeroen M, Nuis Rutger-Jan, Daemen Joost, Kleczynski Pawel, Van Mieghem Nicolas M, Jang Ik-Kyung
Department of interventional Cardiology, Thoraxcenter, Cardiovascular Institute, Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands.
Department of Interventional Cardiology, Jagiellonian University Medical College, Institute of Cardiology, St. John Paul II Hospital, 31-202 Krakow, Poland.
J Clin Med. 2024 May 25;13(11):3096. doi: 10.3390/jcm13113096.
Atherosclerosis is the predominant underlying etiopathology of coronary artery disease. Changes in plaque phenotype from stable to high risk may spur future major adverse cardiac events (MACE). Different pharmacological therapies have been implemented to mitigate this risk. Over the last two decades, intravascular imaging modalities have emerged in clinical studies to clarify how these therapies may affect the composition and burden of coronary plaques. Lipid-lowering agents, such as statins, ezetimibe, and proprotein convertase subtilisin/kexin type 9 inhibitors, were shown not only to reduce low-density lipoprotein levels and MACE but also to directly affect features of coronary plaque vulnerability. Studies have demonstrated that lipid-lowering therapy reduces the percentage of atheroma volume and number of macrophages and increases fibrous cap thickness. Future studies should answer the question of whether pharmacological plaque stabilization may be sufficient to mitigate the risk of MACE for selected groups of patients with atherosclerotic coronary disease.
动脉粥样硬化是冠状动脉疾病的主要潜在病因病理。斑块表型从稳定转变为高风险可能会引发未来的重大不良心脏事件（MACE）。已采用不同的药物疗法来降低这种风险。在过去二十年中，血管内成像模式已出现在临床研究中，以阐明这些疗法如何影响冠状动脉斑块的组成和负担。降脂药物，如他汀类药物、依折麦布和前蛋白转化酶枯草杆菌蛋白酶/kexin 9型抑制剂，不仅能降低低密度脂蛋白水平和MACE，还能直接影响冠状动脉斑块易损性的特征。研究表明，降脂治疗可降低动脉粥样硬化体积百分比和巨噬细胞数量，并增加纤维帽厚度。未来的研究应回答药物性斑块稳定是否足以降低特定组动脉粥样硬化性冠状动脉疾病患者发生MACE风险的问题。
