Bridging the gap for lipid lowering therapy: plaque regression, coronary computed tomographic angiography, and imaging-guided personalized medicine.
Alan C KwanKonstantinos N AronisVeit SandfortRoger S BlumenthalDavid A BluemkePublished in: Expert review of cardiovascular therapy (2017)
Lipid-lowering therapy effectively decreases cardiovascular risk on a population level, but it remains difficult to identify an individual patient's personal risk reduction while following guideline directed medical therapy, leading to overtreatment in some patients and cardiovascular events in others. Recent improvements in cardiac CT technology provide the ability to directly assess an individual's atherosclerotic disease burden, which has the potential to personalize risk assessment for lipid-lowering therapy. Areas covered: We review the current unmet need in identifying patients at elevated residual risk despite guideline directed medical therapy, the evidence behind plaque regression as a potential marker of therapeutic response, and highlight state-of-the-art advances in coronary computed tomographic angiography (CCTA) for measurement of quantitative and qualitative changes in coronary atherosclerosis over time. Literature search was performed using PubMed and Google Scholar for literature relevant to statin therapy and residual risk, coronary plaque regression measurement, and CCTA assessment of quantitative and qualitative change in coronary atherosclerosis. Expert commentary: We discuss the potential ability of CCTA to guide lipid-lowering therapy as a bridge between population and personalized medicine in the future, as well as the potential barriers to its use.
Keyphrases
- coronary artery disease
- coronary artery
- cardiovascular events
- risk assessment
- systematic review
- cardiovascular disease
- computed tomography
- healthcare
- human health
- high resolution
- ejection fraction
- type diabetes
- fatty acid
- end stage renal disease
- aortic stenosis
- peritoneal dialysis
- heavy metals
- risk factors
- case report
- patient reported
- aortic valve
- current status
- mesenchymal stem cells