Subclinical atherosclerosis: what it is, what it means and what we can do about it

Area of Science:

• Cardiology
• Vascular Biology
• Medical Imaging

Background:

• Atherosclerosis is a chronic, inflammatory disease with a long asymptomatic period.
• Progression can lead to acute cardiovascular events like myocardial infarction and sudden cardiac death.
• Subclinical atherosclerosis can be detected using various imaging modalities.

Purpose of the Study:

• To review the identification and management of subclinical atherosclerosis.
• To discuss the role of statin therapy in modifying disease progression.
• To address the controversy surrounding screening and treatment of asymptomatic patients.

Main Methods:

• Review of imaging techniques for atherosclerosis detection (coronary angiography, intravascular ultrasonography, B-mode ultrasonography, CT, MRI).
• Analysis of statin therapy's impact on atherosclerotic plaque burden.
• Evaluation of clinical trial data on statin use in patients with and without overt coronary disease.

Main Results:

• Imaging can identify subclinical atherosclerosis during its asymptomatic phase.
• Statin therapy, depending on intensity, can slow, halt, or reverse atherosclerotic progression.
• Plaque burden reduction in asymptomatic patients lacks definitive correlation with acute event risk reduction.

Conclusions:

• Screening and treating subclinical atherosclerosis remains a subject of debate.
• Statin therapy demonstrates significant risk reduction in clinical trials, irrespective of overt coronary disease.
• Further research is needed to definitively correlate plaque regression with reduced acute coronary event risk in asymptomatic individuals.