Current Atherosclerosis Reports最新文献

Purpose of review: This review examines sex- and gender- specific differences in the pathophysiology, presentation, and clinical complications of atherosclerosis. We explore both traditional and emerging risk factors and identify diagnostic and treatment gaps that disproportionately affect women.

Recent findings: Traditional risk factors such as diabetes and smoking confer greater cardiovascular risk in women than men. Women also experience unique risk factors, including adverse pregnancy outcomes, polycystic ovary syndrome, early menopause, and higher prevalence of autoimmune diseases, that further elevate their risk. Women are more likely to experience ischemia and myocardial infarction in the setting of non-obstructive coronary disease (INOCA/MINOCA). Despite having less plaque than men at any given age, high risk features on cardiac computed tomography angiography carry greater risk. Women are also less likely to receive lipid-lowering agents and other preventive therapies. Recognizing sex-based differences in atherosclerosis is critical to advancing more nuanced, equitable, and personalized cardiovascular disease prevention and care.

Purpose of review: This review examines differences between three large colchicine trials, including study design, trial populations, timing of treatment initiation, colchicine dosing regimens, geographic factors, the timing of trial conduct and inflammatory response.

Recent findings: Colchicine inhibits neutrophil function and affects nucleotide-binding oligomerisation domain-like receptors, pyrin domain-containing 3 (NLRP3) inflammasome activity, thereby reducing the release of downstream pro-inflammatory cytokines such as mature interleukin-1β and interleukin-6. Large randomized controlled trials have evaluated the effects of colchicine in the secondary prevention of coronary artery disease with divergent results. The Colchicine Cardiovascular Outcomes Trial (COLCOT) in patients with recent myocardial infarction (MI) and the Low-Dose Colchicine 2 (LoDoCo2) trial in patients with chronic coronary syndrome showed relative risk reductions of 23% and 31% for major adverse cardiovascular events (MACE). In contrast, the CLEAR SYNERGY trial in patients with recent MI yielded neutral results. Differences between COLCOT, LoDoCo2 and CLEAR SYNERGY provide insights into these aspects of the trials, but do not give definite answers as to why results were divergent. Future detailed analyses of CLEAR SYNERGY, such as stratification by time to treatment initiation, landmark analyses, re-evaluation of events, and assessments of the relationship between inflammatory response and outcomes, could provide additional insights.

Purpose of review: Statins are the most widely prescribed class of drugs for cardiovascular (CV) disease (CVD) prevention due to their potent lipid-lowering effects. However, accumulating evidence demonstrates additional cardioprotective properties of statins mediated through pleiotropic mechanisms unrelated to cholesterol modulation. We aimed to discuss the pleiotropic effects of statins and their relevance to clinical outcomes in 2 reviews: Part I focuses on anti-inflammatory, antioxidant and immunomodulatory effects of statins, whereas Part II on statin-induced endothelial function improvement, plaque stabilization and anti-thrombotic effects. Part II also includes a clinical applications and future directions section.

Recent findings: A literature search was conducted in Embase, Scopus, web of science, PubMed and Cochrane Library databases for experimental and clinical studies investigating the effects of statins on inflammation, oxidative stress and immune function. Statins exert potent anti-inflammatory, antioxidant and immunomodulatory activities that can be linked to reduced CV events. Statins confer cardio protection via diverse pleiotropic pathways distinct from cholesterol modulation. Future directions involve optimizing regimens to maximize clinical benefits, addressing controversies, and exploring statins' therapeutic potential beyond CVD through non-lipid mechanisms. A comprehensive understanding of statins' pleiotropic profile will uncover new preventive strategies and therapeutic applications.

Purpose of review: To summarize key findings from cardiovascular disease prevention trials at the 2025 American Heart Association (AHA) Scientific Sessions.

Recent findings: In a phase 2 trial, DR10624, a novel triple agonist, rapidly led to significant reductions in triglycerides and liver fat in patients with severe hypertriglyceridemia (sHTG). The CORE-TIMI 72a and CORE2-TIMI 72b trials showed that olezarsen markedly lowered triglycerides and reduced the risk of acute pancreatitis in patients with severe hypertriglyceridemia. The VESALIUS-CV trial demonstrated that evolocumab significantly lowered first major cardiovascular events in high-risk adults without prior myocardial infarction or stroke. The CORALreef Lipids trial found that the oral Proprotein Convertase Subtilisin/Kexin Type 9 (PCSK9) inhibitor enlicitide reduced low-density lipoprotein cholesterol (LDL-C) by over 55%, with sustained lipid-lowering effects at 52 weeks. The CORALreef HeFH trial confirmed similar LDL-C reductions in patients with heterozygous familial hypercholesterolemia, supporting enlicitide as an effective oral alternative to injectable PCSK9 inhibitors. The BETTER-BP trial demonstrated that a lottery-based behavioral economics incentive model did not result in a significant reduction of SBP at 6 months. The GoFresh trial found that home-delivered DASH-style groceries, combined with brief counseling, significantly improved systolic blood pressure and LDL-C levels among Black adults living in food-insecure urban settings. The Healthy Family Program in rural China showed that a low-cost, family-centered intervention meaningfully reduced systolic and diastolic blood pressure, with benefits persisting after the program ended. The ELM lifestyle trial showed that a long-term behavioral intervention increased sustained remission of metabolic syndrome while improving multiple cardiometabolic behaviors. Finally, the DECAF trial challenged common assumptions by demonstrating that caffeinated coffee consumption reduced recurrence of atrial fibrillation following cardioversion compared with abstinence. Trials presented at the 2025 AHA Scientific Sessions emphasized new therapeutic, behavioral, and community-based strategies for cardiovascular disease risk reduction. These findings underscore a growing shift toward more effective and accessible approaches to improving cardiovascular health.

Purpose of review: This review examines the role of high-density lipoprotein (HDL) in the context of abdominal aortic aneurysm (AAA). It focuses on the correlation between HDL and AAA risk, while also exploring the mechanisms by which HDL may protect against AAA progression.

Recent findings: Large epidemiological and genetic studies have consistently shown that lower HDL-cholesterol (HDL-C) levels are associated with an increased risk of AAA. HDL exerts a protective effect against AAA formation through its anti-inflammatory, antioxidant, and endothelial protective functions. Recent therapeutic strategies aimed at augmenting HDL functionality, including synthetic HDL (sHDL) and apolipoprotein A-I (ApoA-I) mimetics, have demonstrated promising results in animal models. Current evidence supports a protective role for HDL in AAA pathogenesis. Strategies aimed to improve or mimic HDL function represent promising avenues for future AAA treatment, emphasizing the need for continued translational research and clinical development.

Purpose of review: Atherosclerotic cardiovascular disease (ASCVD) remains a leading cause of morbidity and mortality worldwide. Although there is increasing recognition of sex differences in ASCVD epidemiology, pathogenesis, and clinical outcomes, the underlying biological mechanisms are still insufficiently understood. Women often present with distinct disease phenotypes, such as a higher prevalence of fibrous plaques and microvascular dysfunction, compared with the lipid-rich, inflammatory plaques more typical in men. This review examines recent omics research to clarify the molecular basis of these sex-specific patterns and explores their implications for precision cardiovascular medicine.

Recent findings: Advances in genomics, epigenomics, transcriptomics, proteomics, and metabolomics have shown that sex differences in ASCVD arise from complex hormonal, genetic, epigenetic, and molecular interactions. The variety of available omics approaches offers the potential to discover sex-specific regulatory networks and therapeutic targets, thereby addressing persistent knowledge gaps. However, significant challenges remain, including integrating these diverse omics layers, harmonising datasets across platforms, managing substantial computational demands, and navigating ethical constraints related to data sharing. Multiomics technologies provide unprecedented opportunities to dissect sex-specific mechanisms in ASCVD and to refine individualised risk stratification and therapeutic strategies. Overcoming current analytical and infrastructural barriers through collaborative efforts, standardised methodologies, and responsible data governance will be critical to unlocking the full potential of multiomics in precision cardiovascular medicine. This review synthesises recent evidence across omics domains and underscores their potential to improve ASCVD prevention and treatment.

Purpose of review: Atherosclerotic cardiovascular disease (ASCVD) remains a leading cause of mortality despite optimal LDL-C control, leaving substantial residual risk in patients with atherogenic dyslipidaemia. This review re-examines the evolving role of fibrates in the management of dyslipidaemia, metabolic dysfunction-associated steatotic liver disease (MASLD), chronic kidney disease (CKD), and diabetic microvascular complications.

Recent findings: Large trials have demonstrated modest or inconsistent cardiovascular benefits with fibrates, with effects mainly limited to patients with elevated triglycerides and low HDL-C. The PROMINENT trial confirmed that lowering triglycerides alone does not improve cardiovascular outcomes. However, emerging evidence suggests that fibrates, particularly fenofibrate and pemafibrate, have beneficial effects on albuminuria, hepatic steatosis, and diabetic retinopathy, indicating pleiotropic metabolic benefits beyond lipid lowering. Fibrates remain therapeutically relevant in selected dyslipidaemic or metabolically altered phenotypes. Their future lies in precision metabolic therapy, targeting microvascular, hepatic, and renal complications within a personalised cardiometabolic approach.

Purpose of review: Mental stress has long been overlooked in the development of hypertension. We aim to provide new insights for clinicians in managing this condition.This review aims to summarize the epidemiological characteristics, complex mechanisms, diagnostic methods, as well as both non-pharmacological and pharmacological treatment strategies for mental stress-induced hypertension.

Recent findings: Many hypertensive patients continue to experience fluctuations in blood pressure despite being treated with multiple anti-hypertensive medications. Mental stress-induced hypertension represents a potentially reversible and often underrecognized contributor to cardiovascular risk. Timely identification allows for early, targeted intervention that addresses both hemodynamic control and the underlying psychosocial triggers. Such an approach should combine evidence-based antihypertensive therapy with structured psychological interventions, including validated non-pharmacological measures and pharmacological agents targeting anxiety or depressive symptoms. By integrating cardiovascular and mental health strategies, clinicians can improve long-term blood pressure control, enhance overall patient well-being, and reduce the incidence of adverse cardiovascular events.

Purpose of review: This review synthesizes and discusses evidence from metagenomics, metabolomics, and proteomics on gut microbiome alterations in atherosclerotic cardiovascular disease (ACVD), with carotid atherosclerosis (CAS) serving as an example.

Recent findings: Evidence on gut microbial α-diversity and β-diversity was mixed and differs by disease status. Pro-inflammatory/pathogenic gut bacterial taxa (e.g., Escherichia coli, Klebsiella spp., Streptococcus spp., and Ruminococcus gnavus) were often enriched in patients with ACVD or CAS, whereas short-chain fatty acid (SCFA) producers (e.g., Faecalibacterium prausnitzii, Roseburia spp., Bacteroides spp., and Eubacterium eligens) were depleted. Targeted and untargeted metabolomics implicated multiple microbial-derived metabolites in relation to ACVD and CAS, including trimethylamine N-oxide, short-chain fatty acids, bile acids, lipopolysaccharides, phenylacetylglutamine, indole-3-propionate and imidazole propionate. Gut dysbiosis contributes to ACVD or CAS possibly via metabolite-mediated effects on endothelial function, inflammation, and lipid metabolism. Future research prioritizing longitudinal and interventional studies integrating microbial metagenomics with host multi-omics are needed to elucidate causal pathways and identify clinically actionable targets.