Mercola Joseph
Midwestern University, Downers Grove, IL 60515, United States.
World J Cardiol. 2025 Aug 26;17(8):110163. doi: 10.4330/wjc.v17.i8.110163.
Cardiovascular disease remains the leading global cause of mortality, projected to increase by 73.4% from 2025 to 2050 despite declining age-standardized rates. Contemporary interventions, such as percutaneous coronary intervention and statins, reduce major adverse cardiovascular events (MACE) by 25%-30%, yet a 20% five-year MACE risk persists in high-risk cohorts. These approaches, historically focused on luminal stenosis, fail to address systemic atherogenesis drivers like endothelial dysfunction and inflammation. Specifically, dietary linoleic acid restriction (< 5 g/day) reduces oxidized low-density lipoprotein by approximately 15% by limiting peroxidation-prone bisallylic bonds, mitigating arterial inflammation, a key atherogenic trigger. Enhanced external counterpulsation, through pulsatile shear stress, enhances nitric oxide-mediated coronary perfusion, alleviating angina in approximately 70% of refractory cases unresponsive to revascularization. Nanoparticle-facilitated chelation targets atherosclerotic plaques with precision, reducing calcium content by up to 30% in preclinical models, offering a novel avenue for lesion reversal. These innovations collectively address residual risk by tackling root causes, oxidative stress, endothelial dysfunction, and plaque instability, potentially halving MACE rates with widespread adoption. Despite promising preliminary data, gaps remain in long-term safety and scalability. Robust clinical trials are needed to validate these approaches, which collectively aim to transform cardiovascular disease management by prioritizing prevention and vascular restoration, potentially reducing coronary events to a public health rarity.
心血管疾病仍然是全球主要的死亡原因，尽管年龄标准化发病率有所下降，但预计从2025年到2050年将增加73.4%。当代干预措施，如经皮冠状动脉介入治疗和他汀类药物，可将主要不良心血管事件（MACE）减少25%-30%，但在高危人群中，仍有20%的五年MACE风险持续存在。这些方法历来侧重于管腔狭窄，未能解决诸如内皮功能障碍和炎症等全身性动脉粥样硬化驱动因素。具体而言，饮食中限制亚油酸（<5克/天）通过限制易发生过氧化的双烯丙基键，使氧化型低密度脂蛋白减少约15%，减轻动脉炎症，这是动脉粥样硬化的一个关键触发因素。增强型体外反搏通过脉动剪切应力增强一氧化氮介导的冠状动脉灌注，在约70%对血运重建无反应的难治性病例中缓解心绞痛。纳米颗粒辅助螯合可精确靶向动脉粥样硬化斑块，在临床前模型中使钙含量降低多达30%，为病变逆转提供了一条新途径。这些创新通过解决根本原因、氧化应激、内皮功能障碍和斑块不稳定等问题，共同应对残余风险，广泛采用可能使MACE发生率减半。尽管初步数据很有前景，但在长期安全性和可扩展性方面仍存在差距。需要进行强有力的临床试验来验证这些方法，这些方法共同旨在通过优先预防和血管修复来改变心血管疾病管理，有可能将冠状动脉事件减少到公共卫生领域罕见的程度。
