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[The best of coronary artery disease in 1999]
Insights
Coronary artery disease is a major global health concern. Advances in treatment, including HDL cholesterol management and lifestyle interventions, offer hope for high-risk patients.
Area of Science:
- Cardiovascular Medicine
- Atherosclerosis Research
Context:
- Coronary artery disease (CAD) is a leading cause of mortality globally.
- Emerging economies face increasing CAD prevalence.
- Current therapies benefit only a subset of patients, necessitating improved risk stratification.
Purpose:
- To review current therapeutic strategies and emerging treatments for coronary artery disease.
- To highlight the importance of patient selection for costly interventions.
- To discuss novel approaches including lipid management, diet, and anti-inflammatory pathways.
Summary:
- The MONICA study noted modest regression, but CAD remains a critical issue.
- VA-HIT emphasized HDL cholesterol's role, prompting research into fibrate-statin combinations.
- HOPE study demonstrated ACE inhibitors' efficacy; Mediterranean diet and omega-3 fatty acids show promise in secondary prevention.
- Emerging treatments focus on inflammation, infection, angiogenesis, and vasculogenesis.
Impact:
- Improved patient selection can optimize the use of expensive CAD treatments.
- Integrating lifestyle modifications like the Mediterranean diet and omega-3 fatty acids can enhance secondary prevention.
- Future treatments may leverage understanding of atherosclerosis's inflammatory basis and neovascularization processes.
Abstract:
Despite the (modest) regression observed in the MONICA study, coronary artery disease remains the leading cause of mortality in industrialised countries and it is worryingly progressive in emerging countries. Therapeutic progress has been considerable but only a small number of coronary patients benefit from it. The techniques are costly and justify efforts to improve selection of high risk patients. The results of the VA-HIT study, which demonstrated the importance of HDL cholesterol level in prevention, now raise the question of the optimal treatment of these patients and that of the association of fibrates and statins. The value of ACE inhibitors in the HOPE study in coronary artery disease was outstanding. In parallel, the efficacy of Mediterranean diet has been confirmed in secondary prevention as that of supplements of omega-3 fatty acids in the GISSI-Prevenzione study. When reference anti-anginal agents are ineffective in the most resistant forms of coronary artery disease, other classes of drugs have been shown to be effective in association. Finally, the theory of inflammation and infection of atherosclerosis has found new indirect arguments, whereas angiogenesis and vasculogenesis have been confirmed as the main leaders in the future treatment of coronary artery disease.