在疗法不断扩展的时代重新思考动脉粥样硬化性心血管疾病的预防:稳定斑块能否减少对终身治疗和多种药物的需求?

IF 2 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Current Opinion in Cardiology Pub Date : 2025-01-01 Epub Date: 2024-10-16 DOI:10.1097/HCO.0000000000001188
Kathrine Bruun, Martin Bødtker Mortensen
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引用次数: 0

摘要

综述的目的:在新疗法不断涌现的背景下,本综述研究了药物诱导斑块稳定的现有证据。它探讨了动脉粥样硬化性心血管疾病(ASCVD)预防范式转变的潜力,在这种范式中,治疗可能不需要持续终生才能取得持久疗效:自2015年以来,已有超过14种新型疗法问世,每种疗法都被证明可在他汀类药物和阿司匹林的标准治疗基础上降低ASCVD风险。现在,80% 以上的缺血性心脏病患者都有资格接受一种或多种治疗,这增加了多药治疗、治疗负担和不良副作用的风险。随着更多治疗方法的出现,预计这一挑战将越来越大。摘要:越来越多的新型疗法在预防 ASCVD 的同时又不会导致患者终身使用多种药物和增加患者负担,这给预防 ASCVD 带来了挑战。由于这些药物中有许多是通过稳定斑块发挥作用的,因此一种新的方法可能是可行的--使用这些治疗方法的时间较短,以诱导斑块消退,然后使用强度较低的维持疗法来保持稳定。这种方法值得在今后的研究中进一步探讨。
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Rethinking atherosclerotic cardiovascular disease prevention in the era of expanding therapies: could plaque stabilization reduce the need for lifelong treatments and polypharmacy?

Purpose of review: This review examines current evidence on pharmacologically induced plaque stabilization in the context of a growing range of new therapies. It explores the potential for a paradigm shift in atherosclerotic cardiovascular disease (ASCVD) prevention, where treatments may not need to be lifelong to achieve lasting benefits.

Recent findings: Since 2015, over 14 novel therapies have been introduced, each shown to reduce ASCVD risk when added to standard care with statins and aspirin. More than 80% of ischemic heart disease patients are now eligible for one or more of these treatments, increasing the risk of polypharmacy, treatment burden, and adverse side effects. As more therapies become available, this challenge is expected to grow. Many of these treatments have demonstrated plaque regression and stabilization, as evidenced by both intravascular ultrasound and computed tomography angiography, which likely explains much of their efficacy.

Summary: The increasing number of novel therapies presents challenges in preventing ASCVD without leading to lifelong polypharmacy and increased patient burden. Since many of these drugs act through plaque stabilization, a new approach may be feasible - using these treatments for shorter durations to induce plaque regression, followed by less intensive maintenance therapies to preserve stability. This approach warrants further investigation in future studies.

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来源期刊
Current Opinion in Cardiology
Current Opinion in Cardiology 医学-心血管系统
CiteScore
4.20
自引率
4.30%
发文量
78
审稿时长
6-12 weeks
期刊介绍: ​​​​​​Current Opinion in Cardiology is a bimonthly publication offering a unique and wide ranging perspective on the key developments in the field. Each issue features hand-picked review articles from our team of expert editors. With fourteen disciplines published across the year – including arrhythmias, molecular genetics, HDL cholesterol and clinical trials – every issue also contains annotated reference detailing the merits of the most important papers.
期刊最新文献
Electrographic flow mapping of atrial fibrillation. Ablation options for sub-epicardially located ventricular substrates responsible for ventricular tachycardia: where is it all headed? Rethinking atherosclerotic cardiovascular disease prevention in the era of expanding therapies: could plaque stabilization reduce the need for lifelong treatments and polypharmacy? The management of new-onset atrial fibrillation in critical illness: an update on current therapeutic options. Advancements in automated external and wearable cardiac defibrillators.
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