Advancements in risk stratification and management strategies in primary cardiovascular prevention.
Fotios BarkasYusuf Ziya SenerPelin Arabacilar GolforoushAzin KheirkhahElena Rodriguez-SanchezJan NovakMaria Apellaniz-RuizRalph Kwame AkyeaVanessa BianconiAlexandr CeasovschihYing Jie CheeMariia CherskaJoana Rita ChoraMario D'OriaNadiia DemikhovaDuygu Kocyigit BurunkayaAntoine RimbertChiara MacchiKrishnaraj RathodLynn RothVasily SukhorukovSvetlana StoicaRoberto ScicaliTatyana StorozhenkoJamol UzokovMaria Giovanna LupoEmiel P C van der VorstFlorentina PorschPublished in: Atherosclerosis (2024)
Atherosclerotic cardiovascular disease (ASCVD) remains a leading cause of morbidity and mortality worldwide, highlighting the urgent need for advancements in risk assessment and management strategies. Although significant progress has been made recently, identifying and managing apparently healthy individuals at a higher risk of developing atherosclerosis and those with subclinical atherosclerosis still poses significant challenges. Traditional risk assessment tools have limitations in accurately predicting future events and fail to encompass the complexity of the atherosclerosis trajectory. In this review, we describe novel approaches in biomarkers, genetics, advanced imaging techniques, and artificial intelligence that have emerged to address this gap. Moreover, polygenic risk scores and imaging modalities such as coronary artery calcium scoring, and coronary computed tomography angiography offer promising avenues for enhancing primary cardiovascular risk stratification and personalised intervention strategies. On the other hand, interventions aiming against atherosclerosis development or promoting plaque regression have gained attention in primary ASCVD prevention. Therefore, the potential role of drugs like statins, ezetimibe, proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, omega-3 fatty acids, antihypertensive agents, as well as glucose-lowering and anti-inflammatory drugs are also discussed. Since findings regarding the efficacy of these interventions vary, further research is still required to elucidate their mechanisms of action, optimize treatment regimens, and determine their long-term effects on ASCVD outcomes. In conclusion, advancements in strategies addressing atherosclerosis prevention and plaque regression present promising avenues for enhancing primary ASCVD prevention through personalised approaches tailored to individual risk profiles. Nevertheless, ongoing research efforts are imperative to refine these strategies further and maximise their effectiveness in safeguarding cardiovascular health.
Keyphrases
- cardiovascular disease
- coronary artery
- risk assessment
- artificial intelligence
- randomized controlled trial
- coronary artery disease
- physical activity
- machine learning
- high resolution
- fatty acid
- pulmonary artery
- blood pressure
- human health
- anti inflammatory drugs
- big data
- systematic review
- deep learning
- cardiovascular events
- type diabetes
- heart failure
- pulmonary hypertension
- magnetic resonance
- skeletal muscle
- climate change
- replacement therapy
- blood glucose
- smoking cessation
- drug induced
- contrast enhanced