Current Atherosclerosis Reports最新文献

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.

Purpose of review: The exposome refers to the total environmental exposures a person encounters throughout life, and its relationship with human health is increasingly studied. This non-systematic review focuses on recent research investigating the effects of environmental factors-such as air pollution, noise, greenspace, neighborhood walkability, and metallic pollutants-on atherosclerosis, a major cause of cardiovascular disease.

Recent findings: Studies show that long-term exposure to airborne particulate matter can impair endothelial function and elevate adhesion molecule levels, leading to vascular damage. Nighttime traffic noise also negatively impacts endothelial health. On the other hand, living in areas with more greenspace and better neighborhood walkability is linked to reduced arterial stiffness, suggesting protective cardiovascular effects. Mechanisms involved include oxidative stress, inflammation, and sympathetic activation from air pollution and noise. Metallic pollutants, including lead, cadmium, and arsenic, are linked to early signs of atherosclerosis through mechanisms involving oxidative stress. However, the effects of specific pollutants and their interactions remain incompletely understood. There is a growing need to mitigate harmful environmental exposures, such as air pollution and noise, while promoting beneficial ones like greenspace, to improve cardiovascular health. Emerging technologies like remote sensing and artificial intelligence can help further our understanding of how the exposome influences cardiovascular outcomes. More research is necessary to clarify the impact of specific pollutants as well as their interactions and how they contribute to atherosclerosis.

Purpose of review: Discuss the relationship between pregnancy complications and long-term atherosclerotic cardiovascular disease (ASCVD) risk.

Recent findings: A large body of research confirms an association between pregnancy complications and increased short and long-term ASCVD risk and seeks to understand mechanisms for these associations. Social determinants of health continue to have a critical impact on the prevalence of adverse pregnancy outcomes (APOs) and long term ASCVD risk. Of the APOs, hypertensive disorders of pregnancy (HDP) are associated with the highest ASCVD risk. Additionally, recent research shows an association between APOs and microvascular coronary heart disease. APOs are associated with increased risk of ASCVD, however there is conflicting evidence on whether there is a causal relationship between APOs and ASCVD or if APOs are simply a marker of ASCVD risk. Current ASCVD risk models do not incorporate a history of APOs, therefore it is imperative that healthcare providers take a reproductive health history and account for pregnancy complications when counseling patients on long-term cardiovascular risk. Non-invasive modalities such as coronary artery calcium scoring can be considered as an adjunct, but further research is warranted to determine which patients would benefit most.

Purpose of review: While lipid-lowering therapies demonstrate efficacy, many patients still contend with significant residual risk of atherosclerotic cardiovascular diseases (ASCVD). The intestine plays a pivotal role in regulating circulating lipoproteins levels, thereby exerting influence on ASCVD pathogenesis. This review underscores recent genetic findings from the last six years that delineate new biological pathways and actors in the intestine which regulate lipid-related ASCVD risk.

Recent findings: Specifically, we detail the role of LIMA1 in cholesterol absorption within enterocytes, the function of PLA2G12B in the expansion and lipidation of chylomicrons, the involvement of SURF4 in lipoprotein secretion, and the discovery of a gut-derived hormone named CHOLESIN that modulates cholesterol homeostasis through GPR146 via a gut-liver crosstalk. We further discuss the potential of these newly identified genes and pathways as novel targets for pharmaceutical intervention. Newly identified genetic and intestinal molecular mechanisms offer promising opportunities for preventing and treating ASCVD, but careful evaluation and further research are needed to optimize their clinical application.

Purpose of the review: A significant number of patients fail to achieve target LDL cholesterol (LDL-C) levels. This review aims to explore why inclisiran, a novel class of LLT, should be considered a valuable addition to the current treatment options.

Recent findings: Inclisiran is a small interfering RNA (siRNA) that targets PCSK9 synthesis specifically in the hepatocytes. The drug remains in circulation for less than 48 h, but its effect lasts for over six months. Two subcutaneous injections per year consistently lowers LDL-C by approximately 55% with a favorable safety profile. In combination with other LLTs, it can achieve LDL-C reductions of over 80%, supporting its role in high-intensity LLT strategies. Inclisiran represents a novel class of LLT. Administered biannually, reduces baseline LDL-C levels by half. Additionally, it has a strong safety profile. Due to its pharmacokinetic properties, is likely to improve adherence to LLT and persistently maintain low LDL-C levels.