Current Atherosclerosis Reports最新文献

Purpose of review: Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) and atherosclerotic cardiovascular disease (ASCVD) are familiar co-attendants, while two-way pathophysiological relationships between them are incompletely determined. Mechanisms-insulin resistance, dyslipidemia, inflammation, and endothelial dysfunction-that underlie MASLD-induced atherogenesis are discussed in the narrative. Ascertainment of tools for the risk stratification of ASCVD in the population is also made.

Recent findings: In the last five years, the findings of the cohort studies show MASLD severity is related to subclinical atherosclerosis and future cardiovascular events. New biomarkers (e.g., apolipoprotein B, adipokines) and imaging techniques (e.g., coronary CT angiography) enhance the prediction of risk over the traditional factors. New treatments-GLP-1 receptor agonists and SGLT2 inhibitors-appear to decrease the hepatic steatosis and endpoints of ASCVD, but the use of statins is suboptimal due to the perceived safety issue of the liver. MASLD is a marker and mediator of the risk of ASCVD and thus warrants joint screening and management strategies. Incorporating MASLD-related biomarkers within cardiovascular risk models may be helpful for early detection. High priority for the future is large-scale, randomly controlled clinical studies of combined metabolic therapies to gain dual optimal benefits for the liver and the heart.

Purpose of review: This review summarizes key findings from cardiovascular disease prevention studies presented at the 2025 European Society of Cardiology (ESC) Conference. It highlights trials on novel therapies, vaccination, blood pressure management, and the use of technology and risk scores to guide treatment.

Recent findings: The CONFIDENCE trial showed that a combination of finerenone and empagliflozin significantly reduced the urine albumin-creatinine ratio in patients with type 2 diabetes mellitus and chronic kidney disease. The DANFLU-2 trial found that the high-dose influenza vaccine was associated with fewer cardio-respiratory hospitalizations in older adults compared to the standard dose. The RETREAT FRAIL trial demonstrated that tapering antihypertensive medications in frail, elderly patients safely reduced pill burden without increasing all-cause mortality and adverse cardiovascular (CV) and non-CV outcomes. In diagnostics, the AI-Gatekeeper trial showed an AI tool reduced unnecessary advanced imaging for coronary artery disease (CAD) by 76%, lowering costs without compromising safety. The CAC CV-PREVITAL trial found that adding a coronary artery calcium score to standard risk assessment improved blood pressure control. The REBOOT-CNIC trial challenged a paradigm, showing that beta-blockers provided no significant benefit in post-myocardial infarction patients without reduced ejection fraction. A Post hoc analysis of SURMOUNT-5 found that tirzepatide offers a more pronounced long-term reduction in cardiovascular disease risk compared with semaglutide for adults with obesity and without diabetes. The NATURE-Legacy trial provided compelling evidence for the "legacy benefit" of early, modest reductions in LDL-C and blood pressure. The AIMHY-INFORM Dual Therapy Arm highlighted ethnic differences in blood pressure responses to dual therapy, while the OUTREACH trial demonstrated that providing feedback to patients on antihypertensive adherence using urine testing improved medication adherence. The 2025 ESC Conference featured several impactful studies on cardiovascular disease prevention, highlighting the importance of a multifaceted approach that incorporates the strategic integration of AI and a deeper understanding of patient-specific factors. As cardiovascular disease remains the leading global cause of death, these findings underscore the necessity of moving toward more personalized, evidence-based, and technologically-driven preventive care to improve patient outcomes and reduce the overall disease burden.

Purpose of review: We appraise recent clinical trials, cohort studies, and meta-analyses on dietary and physical activity interventions for prevention and management of high blood pressure.

Recent findings: We identified several notable new findings. Using a new statistical model for estimation of treatment dose-response patterns, potassium supplementation demonstrated a U-curve relationship, in contrast to the linear association for other exposures studied. Recent salt substitute reports document substantial BP lowering and prevention of cardiovascular and all-cause mortality. A large and statistically powerful alcohol dose-response meta-analysis of prospective cohort studies suggests there is no beneficial or safe level for alcohol consumption. Finally, large meta-analyses suggest isometric resistance exercise has substantial capacity to lower BP. A major area of uncertainty remains how best to implement the desired dietary and physical activity interventions. In addition to confirming and expanding core knowledge for the role of diet and physical activity in the etiology, prevention and management of high blood pressure, reports during the last 5 years have added to our understanding of dose-response relationships for sodium, potassium, physical activity, and alcohol consumption with high blood pressure, have detailed the efficacy of new treatment options, and have ighlighted areas of continuing uncertainty.

Purpose of review: This review synthesises current evidence on the cardiovascular disease (CVD) burden among young people living with HIV. It explores myocardial and vascular pathology, evaluates the role of advanced imaging, and highlights critical gaps in understanding the mechanisms driving HIV-associated CVD in this population.

Recent findings: Emerging data suggest that HIV-associated CVD in youth may be predominantly driven by non-atherosclerotic mechanisms, including direct myocardial injury, fibrosis, and remodelling, rather than traditional coronary atherosclerosis. Imaging studies have revealed subclinical myocardial changes such as increased left ventricular mass and reduced strain. Vascular studies show inconsistent findings. However, longitudinal data and multimodal imaging approaches remain scarce, particularly in high-burden regions like Africa. Young adults with HIV face a significant burden of cardiovascular pathology, often subclinical and poorly understood. The prevailing paradigm focused on atherosclerosis may not fully apply to this group, especially in African settings. There is an urgent need for longitudinal, mechanistic research to inform tailored clinical strategies and policy interventions aimed at reducing long-term cardiovascular morbidity in young people with HIV.

Purpose of review: Dysfunction of the ATP-binding cassette G5/G8 heterodimier (ABCG5/G8) leads to sitosterolemia, a condition in which premature atherosclerosis is often observed, thereby linking elevated circulating phytosterols to atherogenicity. Conversely, consumption of phytosterols reduces circulating cholesterol levels and, in animal studies, is anti-atherogenic. The debate over phytosterols' benefits vs. harms continues without consensus. Two key issues remain: despite extensive research, the etiology of premature atherosclerosis in sitosterolemia is still uncertain, and discussion of phytosterol atherogenicity has not been grounded in quantitative evidence, hindering true risk assessment.

Recent findings: In this review, we conducted a meta-analysis of circulating cholesterol and phytosterol levels prior to medical interventions in individuals with sitosterolemia. The analysis revealed that severe hypercholesterolemia manifests in the first decade of life but declines rapidly into adulthood, suggesting the presence of hypercholesterolemia-induced atherosclerotic cardiovascular disease (ASCVD). Although ABCG5/G8-deficient animal models recapitulate the symptoms of sitosterolemia, including hematologic abnormalities and organ dysfunction, increased atherogenicity has not been observed in these models. By contrast, the consumption of phytosterol-supplemented foods minimally influences circulating phytosterol levels in the general population and lowers circulating cholesterol levels by approximately 10%. Mendelian randomization studies have indicated an association between circulating phytosterol levels and ASCVD risk; however, genetic background, sterol absorption efficiency, and metabolic disturbances modulate these levels, potentially confounding the interpretation of such associations. This review reframes the phytosterol atherogenicity debate through quantitative assessment and clarifies longstanding uncertainties about phytosterol safety, thus contributing to evidence-based risk evaluation and supporting informed clinical and dietary recommendations.

Purpose of review: Apolipoprotein C-III (apoC-III) is a central regulator of triglyceride metabolism. Elevated triglyceride levels are associated with increased risk of acute pancreatitis and atherosclerotic cardiovascular disease (ASCVD).

Recent findings: Conventional triglyceride-lowering therapies, such as fibrates and omega-3 fatty acids, have limited efficacy in reducing triglycerides and in reducing the risk of pancreatitis or ASCVD in patients with severe hypertriglyceridemia. ApoC-III inhibits lipoprotein lipase and impairs clearance of both triglyceride-rich and cholesterol-rich lipoproteins. Novel therapies targeting APOC3 mRNA to reduce triglycerides, including antisense oligonucleotides (ASOs) and small interfering RNAs (siRNAs), achieve greater triglyceride reductions than standard agents. Volanesorsen and olezarsen, both ASOs, are approved as an adjunct to diet to reduce triglycerides in familial chylomicronemia syndrome (FCS) in different regions. Plozasiran, an siRNA, is in late-stage clinical development. Indirect cross-trial comparisons were performed, aligned by timepoint and outcome measures, and indicate comparable efficacy of olezarsen and plozasiran in patients with chylomicronemia. APOC3 inhibition is now an established therapeutic approach for reducing the risk of acute pancreatitis in FCS, with three agents, volanesorsen, olezarsen, and plozasiran, demonstrating efficacy. However, its role in ASCVD prevention remains unproven. This review evaluates current APOC3 - targeted therapies for FCS, including available comparative data, and synthesizes the emerging literature on the potential of APOC3 inhibition to reduce the burden of acute pancreatitis in broader populations with severe hypertriglyceridemia, as well as its potential role in ASCVD risk reduction.

Purpose of review: Cardiac computed tomography (CCT) is now an essential noninvasive imaging modality for evaluating a broad range of cardiovascular conditions. This review summarizes the most recent recommendations from the American College of Cardiology/American Heart Association (ACC/AHA) and the European Society of Cardiology (ESC), providing an updated overview of the evolving role of CCT in risk assessment, chest pain evaluation, structural heart disease, arrhythmias, and perioperative management.

Recent findings: Compared to prior guidelines issued between 2008 and 2015, the number of CCT-related recommendations has significantly increased from 42 to 51 in the ACC/AHA guidelines, and from 20 to 31 in the ESC guidelines. This growth reflected the broadening role of CCT in the assessment of coronary artery disease, acute and stable chest pain, valvular and congenital heart disease, arrhythmias, and perioperative risk stratification. Additionally, the review highlighted emerging applications such as CT-derived fractional flow reserve (FFR-CT) and CCT-guided planning for structural interventions. By consolidating and contextualizing current recommendations, this work underscores the vital and continuously evolving role of CCT in cardiovascular practice.

Purpose of review: Discuss the effects of menopause and menopause hormone therapy (MHT) on cardiovascular risk, and propose a structured, person-centered framework for cardiovascular risk assessment when initiating MHT.

Recent findings: The risk of atherosclerotic heart disease accelerates during the menopause transition due to hormonal, metabolic, and vascular changes. Both menopause and MHT affect cardiovascular risk factors (i.e. blood pressure, lipids, insulin resistance) and cardiovascular events (i.e. myocardial infarction and stroke). Early clinical trial evidence demonstrated that oral synthetic MHT, including conjugated equine estrogen (CEE) with medroxyprogesterone acetate (MPA), is associated with increased coronary heart disease and stroke risk, particularly in older, postmenopausal women. Contemporary formulations such as low-dose transdermal estrogen and micronized progesterone have lower cardiovascular risk. A personalized assessment when initiating MHT should consider age, time since menopause, baseline cardiovascular (CV) risk, and choice of MHT formulation. Assessment of baseline CV risk should include a comprehensive review of traditional CV risk factors and consideration of risk-enhancing factors (including female-specific risk factors) and imaging for subclinical atherosclerosis (i.e. coronary artery calcium scoring) to provide a person-centered risk assessment. Menopause is an important period to implement prevention strategies to reduce future incidence CVD. A structured, individualized approach that accounts for the timing, formulation and delivery of MHT can optimize cardiovascular safety. This review provides a framework for personalized decision-making and highlights the need for further research to clarify MHT's impact on long-term CV outcomes.

Purpose of review: This review explores the role of artificial intelligence (AI) in visceral adipose tissue (VAT) and ectopic fat imaging. It aims to evaluate how AI may be used to enhance the efficiency and accuracy of cardiovascular disease (CVD) risk assessment. It addresses key questions regarding AI's capabilities in risk prediction, segmentation, and integration with large volume data for CVD risk assessment.

Recent findings: Recent studies demonstrate that AI, powered by deep learning models, significantly improve VAT and ectopic fat segmentation. AI can also be used to facilitate early detection of cardiometabolic risks and allows integration of imaging with clinical data for a more personalized approach to medicine. Emerging applications include AI-enabled telehealth and continuous monitoring through wearable technologies. AI is transforming VAT and ectopic fat imaging by enabling more precise, personalized, and scalable assessments of fat distribution and cardiovascular risk. While challenges remain, such as model interpretability, future research will likely focus on refining algorithms and expanding AI's clinical applications, potentially redefining obesity and CVD risk management.

Purpose of review: Cardiovascular disease (CVD) continues to exact a heavy toll across the Middle East and North Africa. We analyzed Global Burden of Disease 2021 data to characterize trends in CVD mortality, disability‑adjusted life‑years (DALYs), and incidence from 1990 to 2021, identify leading risk factors, and highlight country‑level disparities that inform policy action.

Recent findings: Age‑standardized CVD death rates declined by 31% and DALY rates by 36% over three decades, while incidence fell only 8%. Progress was highly uneven: Lebanon and Qatar cut DALYs by > 60%, whereas Libya's burden rose and Egypt still records > 12 000 DALYs per 100,000. Metabolic risks including obesity, hypertension, dyslipidemia, and hyperglycemia accounted for nearly half of 2021 DALYs. This contribution outweighed that of behavioral and environmental risks, despite sizeable declines in tobacco use and air-pollution exposure. Countries with robust data systems and universal coverage achieved the fastest gains; conflict‑affected or lower‑income states lagged markedly. Although regional CVD burden is trending downward, persistent heterogeneity and the rising dominance of metabolic risk highlight an urgent need for prevention‑centered, context‑specific strategies. Strengthening primary care, expanding registries, integrating digital health and environmental surveillance, and fostering cross‑country collaboration will be critical to sustain and equalize cardiovascular progress across the Middle East and North Africa.