Current Atherosclerosis Reports最新文献

Purpose of the review: Hypercholesterolemia is a significant and modifiable risk factor for cardiovascular disease (CVD), with Low-Density Lipoprotein Cholesterol (LDL-C) being the primary target for lipid-lowering therapies in both primary and secondary prevention. This review aims to explore the efficacy of statin therapy in women, its safety and application during pregnancy, and treatment disparities that contribute to undertreatment of dyslipidemia in women.

Recent findings: Statins has demonstrated efficacy in reducing LDL-C and CVD risk in women. However, women are less likely to achieve LDL-C targets compared to men, largely due to undertreatment and delays in initiating therapy, often influenced by sex-specific factors. The unique considerations of lipid management during pregnancy, including suspension of statin therapy, present additional challenges in achieving optimal lipid control in high-risk women. Evidence also points to systemic disparities in healthcare delivery and treatment allocation, further exacerbating undertreatment of dyslipidemia among women. While LDL-C lowering remains a cornerstone of CVD prevention, women face distinct challenges in achieving lipid goals due to biological, clinical, and healthcare disparities. Addressing these barriers, including improving timely initiation of statins and addressing gaps in care during pregnancy, is essential to enhance the dyslipidemia management and reduce CVD risk in women.

Purpose of review: This paper reviews the existing literature on lipidomics as a tool for improved cardiovascular risk estimation in both primary and secondary prevention populations.

Recent findings: Detailed lipidomic signatures identified by mass spectrometry have been shown to enhance risk estimation for clinical CAD and the presence of subclinical CAD on CTCA in multiple large cohort populations. In patients with established atherosclerotic disease, ceramide and phospholipid-based risk scores improve prediction for recurrent cardiovascular events and cardiovascular death. Lipidomic profiles and lipidomic-enhanced risk scores have been shown to improve prediction of incident cardiovascular disease, recurrent cardiovascular events and cardiovascular death independent of traditional risk factors. Simplified risk scores utilizing the ratios of several ceramide species improve clinical utility, however resources and infrastructure limit widespread implementation. There are currently no therapeutics to address lipidomic risk aside from traditional risk factor modification.

Purpose of review: This narrative review aims to synthesize global literature on the relationship between cardiovascular diseases (CVD) and components of built environment (green spaces, walkability, food environment, accessibility and availability of recreational and healthcare facilities, and effects of air and noise pollution).

Recent findings: Increased green space and neighborhood walkability are associated with lower CVD mortality and morbidity; however, benefits have shown differential effects by socioeconomic status (SES). Air pollution is a leading environmental risk factor contributing to CVDs, and it disproportionately impacts low SES populations and women. Findings on relationships between food environment and CVDs are inconsistent and limited. This global review reports on the multifactorial and complex relationship between built environment and higher CVD risk and poor CVD outcomes. Future research can address an unmet need to understand this relationship with further depth and breadth, and to investigate resulting health disparities.

Purpose of review: High-density lipoprotein (HDL) is integral to reverse cholesterol transport (RCT), a process considered to protect against atherosclerotic cardiovascular disease (ASCVD). We summarise findings from the recent AEGIS-II trial and discuss new opportunities for HDL therapeutics targeted at RCT.

Recent findings: Mendelian randomisation studies have suggested a causal association between the functional properties of HDL and ASCVD. However, the AEGIS-II trial of CSL112, an apolipoprotein A-I therapy that enhances cholesterol efflux, did not meet its primary endpoint. Exploratory analyses demonstrated that CSL112 significantly reduced ASCVD events among participants with a baseline low-density lipoprotein (LDL)-cholesterol ≥ 100 mg/dL, suggesting that RCT may depend on LDL-cholesterol levels. The role of HDL therapeutics in patients with familial hypercholesterolaemia, inherited low HDL-cholesterol and impaired HDL function, especially with inadequately controlled LDL-cholesterol, merits further investigation. The treatment of patients with monogenic defects in HDL metabolism remains a significant gap in care that needs further research.

Purpose of review: Our review emphasizes recent advancements and persisting gaps in cardiovascular genomics, particularly highlighting how emerging studies involving underrepresented populations have uncovered new genetic variants associated with cardiovascular diseases.

Recent findings: Initiatives like the H3Africa project, the Million Veterans Program, and the All of Us Research Program are working to address this gap by focusing on underrepresented groups. Additionally, emerging research is centering on the interplay between genetic factors and socio-environmental determinants of health, which disproportionately impact marginalized communities. As cardiovascular genomics research grows, increasing the inclusion of underrepresented populations is essential for gaining a more comprehensive understanding of genetic variability. This will lead to more accurate and clinically meaningful strategies for preventing and treating cardiovascular diseases across all ancestral backgrounds and diverse populations.

Purpose of review: The role that sex plays in the incidence and outcomes of PCI related complications is not well understood. The purpose of this review is to highlight the commonly encountered peri-procedural complications and search for any sex differences in the published literature.

Recent findings: Procedure related complications and long-term cardiovascular outcomes remain worse in women. The delayed presentation of women with coronary events and delayed referral for an invasive diagnostic angiogram and subsequent revascularization likely contribute to the worse outcomes. Whether the smaller vessel size, residual Syntax Score, and other biological factors impact periprocedural outcomes is controversial and warrants device and procedure specific research to identify sex differences. Modern day percutaneous revascularization has achieved very high acute procedural success rates and low complication rates with the advent of structured training programs, development of appropriate use criteria and refined devices and technologies in the catheterization laboratory. However, both procedure related complications and long-term cardiovascular outcomes remain worse in women.

Purpose of review: The use of statins has transformed approaches to the prevention of cardiovascular disease. However, many patients remain at a major risk of experiencing cardiovascular events, due to a range of factors including suboptimal control of low-density lipoprotein cholesterol (LDL-C). Accordingly, there is an ongoing need to develop additional strategies, beyond the use of statins, to achieve more effective reductions in cardiovascular risk.

Recent findings: Genomic studies have implicated the causal role of LDL in atherosclerosis and identified that polymorphisms influencing factors involved in lipid metabolism influence both the level of LDL-C and cardiovascular risk. These findings have highlighted the potential for cardiovascular benefit from development of therapies targeting these factors and incremental benefit when used in combination with statins. Clinical trials have demonstrated that these new agents have favourable effects on both atherosclerotic plaque and cardiovascular events. Additional work has sought to improve intensification of statin therapy and adherence with lipid lowering therapy, to achieve more effective cardiovascular prevention via lipid lowering. Emerging therapies, beyond statins, have the potential to optimise lipid levels and play an effective role in the prevention of cardiovascular disease.

Purpose of review: This review aims to assess the role of mobile health (mHealth) interventions and wearable technologies in the prevention and management of atherosclerotic cardiovascular disease (ASCVD). We sought to explore the benefits, challenges, and equity implications of these digital health modalities, with a focus on improving patient outcomes and reducing ASCVD risk.

Recent findings: Recent studies have shown that mHealth interventions and wearable devices effectively promote healthy behaviors, offer real-time physiological monitoring, and aid in the early prevention of ASCVD by targeting key risk factors such as metabolic syndrome and sedentary lifestyles. These technologies hold great potential for improving patient engagement and enabling timely interventions. However, challenges such as technological constraints, high costs, and gaps in digital literacy significantly hinder their broader adoption, particularly among disadvantaged populations. In summary, our findings highlight the critical need for accessible, affordable, and inclusive digital health solutions to prevent and manage ASCVD, promoting more equitable healthcare delivery. To maximize these benefits, future research should focus on harnessing artificial intelligence and digital markers to improve early event prediction and develop personalized preventive strategies.

Purpose of review: Focused review highlighting ten select studies presented at the 2024 American Heart Association (AHA) Scientific Sessions.

Recent finding: Included studies assessed effects of intensive blood pressure control in patients with type 2 diabetes (BPROAD); decision support system for physicians to optimize early lipid lowering therapies after acute coronary syndrome (ZODIAC); efficacy and safety of zerlasiran, a short interfering RNA targeting lipoprotein(a) (ALPACAR); efficacy and safety of muvalaplin an oral disrupter of the assembly of lipoprotein(a) particles (KRAKEN); safety and efficacy of obicetrapib in patients with heterozygous familial hypercholesterolemia (BROOKLYN); efficacy and safety of lerodalcibep, a third generation PCSK9 inhibitor in heterozygous familial hypercholesterolemia subjects (LIBerate-HeFH_OLE); personalized app-based coaching to improve physical activity in patients with HFpEF compared to standard care (MyoMobile); semaglutide to improve cardiovascular outcomes in patients with a history of coronary artery bypass surgery and overweight or obesity (the SELECT trial); efficacy and safety of plozasiran in adults with genetically or clinically defined familial chylomicronemia syndrome at high risk of acute pancreatitis (PALISADE); and transcriptomic signatures and predictors of evolocumab added to maximum statin therapy based on intra-coronary plaque characteristics (YELLOW III). Research presented at the 2024 AHA Scientific Sessions emphasized innovative strategies in cardiovascular disease prevention and management.

Purpose of review: The purpose of this review is to provide an overview of the current status of lipid-lowering therapy utilization and lipid goal attainment in women. We focus on lipid-lowering therapy in individuals with and without established atherosclerotic cardiovascular disease, as well as familial hypercholesterolemia. Additionally, this review aims to explore the underlying mechanisms driving these sex differences and to identify existing knowledge gaps in this area.

Recent findings: Despite the proven efficacy of lipid-lowering therapy in both sexes, real-world studies indicate that women with comparable risk profiles are less likely than men to receive these treatments. Furthermore, women who are prescribed statins typically receive lower-intensity regimens than men and are less likely to achieve guideline-recommended low-density lipoprotein cholesterol goals. Despite advancements in lipid-lowering therapies, women compared to men, are systematically undertreated. This difference is influenced by patient-related, physician-related, and societal factors.