Current Atherosclerosis Reports最新文献

Purpose of review: Statins are first-line pharmacotherapy for the treatment of elevated low-density lipoprotein cholesterol and are generally well-tolerated. However, some patients may experience statin-associated muscle symptoms (SAMS). This paper reviews recommendations for identification and management of patients with SAMS.

Recent findings: The National Lipid Association and other professional societies have issued guidance to assist clinicians in identifying and managing patients with partial or complete statin intolerance. The most common reason for intolerance is SAMS. This review discusses strategies to achieve therapeutic objectives for atherogenic lipoprotein management in patients with SAMS. Many patients who experience SAMS can tolerate some degree of statin therapy and non-statin medications are available as adjunctive or alternative treatments. With a thorough clinician-patient discussion and shared decision-making, a treatment plan can be identified to achieve therapeutic objectives and reduce the risk of atherosclerotic cardiovascular disease.

Purpose of review: There is a growing recognition of plaque erosion as a cause of acute coronary syndrome. This review aims to examine the potential involvement of T cells in this process.

Recent findings: Immune-vascular interactions have been identified in the development of plaque erosions. Up to one-third of eroded plaques show evidence of active immune infiltration, with the presence of T cells. We propose that microerosions may frequently occur in association with the infiltration of T cells and macrophages in early atherosclerotic lesions. Healing of erosions could trigger the deposition of excessive extracellular matrix. The pro-inflammatory and cytotoxic actions of T cells, along with reduced endothelial integrity and other mechanisms, may subsequently give rise to clinical symptoms. To gain a better understanding of the role of T cells in plaque erosion, it is crucial to develop improved models for conducting controlled experiments and to study atherosclerosis in younger individuals.

Purpose of review: Multiple agents are being developed that inhibit apolipoprotein (apo) C-III. This state-of-the-art review examines their potential for atherosclerotic cardiovascular disease (ASCVD) risk reduction.

Recent findings: Apo C-III, an apolipoprotein on the surface of triglyceride-rich lipoproteins (TRLs), impairs clearance of TRLs through both lipoprotein lipase dependent and independent pathways, thereby resulting in increased concentrations of triglycerides. Apo C-III has also been shown to have pro-atherogenic effects when bound to high-density lipoprotein (HDL) particles. Classical and genetic epidemiology studies provide support for the concept that apo C-III is associated with an increased risk of ASCVD events. Drug efficacy of agents that silence APOC3 mRNA has been studied in populations with varying hypertriglyceridemia severity, including those with familial chylomicronemia syndrome, multifactorial chylomicronemia syndrome/severe hypertriglyceridemia, and mixed hyperlipidemia. Randomized controlled trials have reported significant reductions in TG and non-HDL cholesterol levels among these patients treated with APOC3 inhibitors. Upcoming clinical outcomes trials seek to establish a role for APOC3 inhibitors to reduce risk of ASCVD.

Purpose of review: Statins are the first-line treatment for hypercholesterolemia and play a key role in the prevention of cardiovascular disease (CVD). Current studies report mixed effects of statins on cognitive health, including harmful, neutral, and protective outcomes. However, these ongoing controversies about the potential cognitive adverse effects of statins may compromise their use in CVD prevention. Several factors may influence how statins affect cognition, including the unique cholesterol homeostasis in the brain, the limited permeability of the blood-brain barrier to lipoproteins, and the varying lipophilicity of different statins. This review examines the evidence linking statins to cognitive function and considers the effect of different dosages and treatment durations.

Recent findings: Earlier studies suggested cognitive disturbances with statins, but recent evidence does not strongly support a link between statins and cognitive impairment. In fact, observational studies suggest potential neuroprotective benefits, though biases like selection bias, confounding and reverse causation limit definitive conclusions. Two large randomized controlled trials, STAREE and PREVENTABLE, are underway, and their results are expected to address some of these gaps in the literature. Due to insufficient evidence in the current literature, well-designed randomized controlled trials are needed for a better understanding of statins' effects on cognition. More data is needed regarding statin type, dose intensity, and treatment duration, which may affect cognitive outcomes. Future studies are also needed to examine how statins may affect cognition in specific high-risk groups, such as individuals with mild cognitive impairment, diabetes, cardiovascular disease, or chronic kidney disease.

Purpose of review: This review aims to elucidate the multifaceted role of iron in the pathogenesis of atherosclerosis. The primary objective is to summarize recent advances in understanding how iron contributes to atherosclerosis through various cellular mechanisms. Additionally, the review explores the therapeutic implications of targeting iron metabolism in the prevention and treatment of cardiovascular diseases.

Recent findings: A growing body of literature suggests that excess iron accelerates the progression of atherosclerosis, with the deleterious form of iron, non-transferrin-bound iron (NTBI), particularly exacerbating this process. Furthermore, iron overload has been demonstrated to play a pivotal role in endothelial cells, vascular smooth muscle cells, and macrophages, contributing to plaque instability and disease progression by promoting lipid peroxidation, oxidative stress, inflammatory responses, and ferroptosis. Iron plays a complex role in atherosclerosis, influencing multiple cellular processes and promoting disease progression. By promoting oxidative stress, inflammation, and ferroptosis, iron exacerbates endothelial dysfunction, smooth muscle cell calcification, and the formation of macrophage-derived foam cells. Targeted therapies focusing on iron metabolism have proven effective in treating atherosclerosis and other cardiovascular diseases.

Purposeof review: A heart-healthy lifestyle adopted during childhood and sustained throughout life can reduce cardiovascular disease risk in youth with dyslipidemia. In this review, we discuss nutrition recommendations for youth (< 18 years-of-age) with dyslipidemia, compare recommendations for youth versus those for adults, review published data regarding nutrition management in the pediatric population, and discuss strategies for successful implementation in a clinical setting.

Recent findings: Recent publications highlight the characteristics of genetic and acquired hypertriglyceridemia disorders, dietary adjuncts used for lipid-lowering, and the effectiveness of a multi-disciplinary team approach. Nutrition interventions remain a cornerstone of lipid management and cardiovascular disease risk reduction in youth with dyslipidemia. Nutrition counseling should include age and developmentally appropriate education while also addressing barriers to implementing a heart-healthy lifestyle. A registered dietitian nutritionist plays an important role within a multidisciplinary clinic setting by providing dietary recommendations to address the needs of youth with dyslipidemia.

Purpose of review: The rising burden of cardiovascular disease (CVD) in Africa is of great concern. Health data sciences is a rapidly developing field which has the potential to improve health outcomes, especially in low-middle income countries with burdened healthcare systems. We aim to explore the current CVD landscape in Africa, highlighting the importance of health data sciences in the region and identifying potential opportunities for application and growth by leveraging health data sciences to improve CVD outcomes.

Recent findings: While there have been a number of initiatives aimed at developing health data sciences in Africa over the recent decades, the progress and growth are still in their early stages. Its maximum potential can be leveraged through adequate funding, advanced training programs, focused resource allocation, encouraging bidirectional international partnerships, instituting best ethical practices, and prioritizing data science health research in the region. The findings of this review explore the current landscape of CVD and highlight the potential benefits and utility of health data sciences to address CVD challenges in Africa. By understanding and overcoming the barriers associated with health data sciences training, research, and application in the region, focused initiatives can be developed to promote research and development. These efforts will allow policymakers to form informed, evidence-based frameworks for the prevention and management of CVDs, and ultimately result in improved CVD outcomes in the region.

Purpose of review: To summarize the recent evidence and guideline recommendations on aspirin or P2Y₁₂ inhibitor monotherapy in patients with stable ischemic heart disease and provide insights into future directions on this topic, which involves transition to a personalized assessment of bleeding and thrombotic risks.

Recent findings: It has been questioned whether the evidence for aspirin as the foundational component of secondary prevention in patients with coronary artery disease aligns with contemporary pharmaco-invasive strategies. The recent HOST-EXAM study randomized patients who had received dual antiplatelet therapy for 6 to 18 months without ischemic or major bleeding events to either clopidogrel or aspirin for a further 24 months, and demonstrated that the patients in the clopidogrel arm had significantly lower rates of both thrombotic and bleeding complications compared to those in the aspirin arm. The patient-level PANTHER meta-analysis showed that in patients with established coronary artery disease, P2Y₁₂ inhibitor monotherapy was associated with lower rates of myocardial infarction, stent thrombosis as well as gastrointestinal bleeding and hemorrhagic stroke compared to aspirin monotherapy, albeit with similar rates of all-cause mortality, cardiovascular mortality and major bleeding. Long-term low-dose aspirin is recommended for secondary prevention in patients with stable ischemic heart disease, with clopidogrel monotherapy being acknowledged as a feasible alternative. Dual antiplatelet therapy for six months after percutaneous coronary intervention remains the standard recommendation for patients with stable ischemic heart disease. However, the duration of dual antiplatelet therapy may be shortened and followed by P2Y₁₂ inhibitor monotherapy or prolonged based on individualized evaluation of the patient's risk profile.

Purpose of review: Family history of premature cardiovascular disease is a strong predictor of individual cardiovascular risk. However, family history is not always available and not always reliable. Roughly 80% of health outcomes are influenced not by genetic risk but by societal factors, including adverse health behaviors and environment. Furthermore, in the present age of genetic testing, laboratory evaluations, and imaging, a key question remains: What is the contemporary relevance of family history screening in the management of cardiovascular disease in youth?

Recent findings: Knowledge of an individual's family history can help clinicians identify not only inherited risk but also familial clustering of unhealthy behaviors and environmental adversity contributing to enhanced cardiovascular disease risk in youth. For those at greatest risk, prevention strategies can be applied sooner and more conservatively. Integrating family history into clinical practice is crucial for cardiovascular risk assessment and for optimizing outcomes, but, in some cases, is more reflective of social factors.

Purpose of review: Health data sciences can help mitigate high burden of cardiovascular disease (CVD) management in South Asia by increasing availability and affordability of healthcare services. This review explores the current landscape, challenges, and strategies for leveraging digital health technologies to improve CVD outcomes in the region.

Recent findings: Several South Asian countries are implementing national digital health strategies that aim to provide unique health account numbers for patients, creating longitudinal digital health records while others aim to digitize healthcare services and improve health outcomes. Significant challenges impede progress, including lack of interoperability, inadequate training of healthcare workers, cultural barriers, and data privacy concerns. Leveraging digital health for CVD management involves using big data for early detection, employing artificial intelligence for diagnostics, and integrating multiomics data for health insights. Addressing these challenges through policy frameworks, capacity building, and international cooperation is crucial for improving CVD outcomes in region.