Is electrical neuromodulation able to affect the extent and stability of coronary atheromatous plaques?

We read with interest the thorough review article on neuromodulation in patients with refractory angina pectoris, by Fabienne Vervaat and colleagues published in the January 2023 issue of European Heart Journal Open. 1 In addition to the mechanisms presented, it may be relevant to pay attention to recent very intriguing developments in the role of the nervous system in the vascular and the immune systems that may impact on the perception of neuromodulation as a therapy and its possible effect on atheroma plaques. Mahanta and colleagues found in apolipoprotein E– deficient (Apoe − / − ) mice that the density of both sensory and sympathetic nerve fibres was abundant in the aortic adventitia and these were greatly increased in areas of atherosclerotic plaques. 2 Using virus tracing techniques, they showed that these fibres establish a structural artery– brain circuit (ABC) with the sensory arm entering the CNS via dorsal root ganglia in the spinal cord and which connect to higher brain regions. The efferent arm of the ABC projects from hypothalamic