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Quantification of Atherosclerosis in Mice
Published on: June 12, 2019
Residual risks and evolving atherosclerotic plaques
Sunil K Noothi1, Mohamed Radwan Ahmed1, Devendra K Agrawal2
1Department of Translational Research, Western University of Health Sciences, 309 E. Second Street, Pomona, CA, USA.
Insights
Despite advanced treatments for atherosclerotic diseases, a significant residual risk of cardiovascular events and strokes persists. Understanding plaque evolution is key to managing this persistent risk in coronary and carotid arteries.
Area of Science:
- Cardiovascular Medicine
- Vascular Biology
- Epidemiology
Background:
- Atherosclerotic disease in coronary and carotid arteries is a leading global cause of mortality and morbidity.
- Despite advances in revascularization, statins, and risk factor modification, a substantial residual risk remains.
- This residual risk contributes to prevalent and new cases of cardiovascular events and strokes annually.
Purpose of the Study:
- To highlight the global burden of atherosclerotic diseases.
- To present clinical evidence of residual risks in atherosclerotic diseases despite advanced management.
- To discuss evolving plaque concepts, biology, and progression mechanisms.
Main Methods:
- Review of clinical evidence on residual risks in atherosclerotic diseases.
- Critical discussion of plaque evolution and underlying mechanisms.
- Utilizing advanced imaging techniques like intravascular ultrasound, optical coherence tomography, and near-infrared spectroscopy.
Main Results:
- Advanced imaging provides unprecedented detail on plaque characteristics (size, composition, lipid volume, fibrous cap thickness).
- These insights enhance understanding of plaque progression from stable to unstable states.
- Understanding plaque evolution aids in predicting major adverse atherothrombotic events.
Conclusions:
- Atherosclerotic diseases continue to pose a significant health burden globally.
- Residual risk in cardiovascular and cerebrovascular events necessitates further research and improved management strategies.
- Advanced intravascular imaging techniques are crucial for characterizing plaque and informing clinical decisions.
Abstract:
Atherosclerotic disease of the coronary and carotid arteries is the primary global cause of significant mortality and morbidity. The chronic occlusive diseases have changed the epidemiological landscape of health problems both in developed and the developing countries. Despite the enormous benefit of advanced revascularization techniques, use of statins, and successful attempts of targeting modifiable risk factors, like smoking and exercise in the last four decades, there is still a definite "residual risk" in the population, as evidenced by many prevalent and new cases every year. Here, we highlight the burden of the atherosclerotic diseases and provide substantial clinical evidence of the residual risks in these diseases despite advanced management settings, with emphasis on strokes and cardiovascular risks. We critically discussed the concepts and potential underlying mechanisms of the evolving atherosclerotic plaques in the coronary and carotid arteries. This has changed our understanding of the plaque biology, the progression of unstable vs stable plaques, and the evolution of plaque prior to the occurrence of a major adverse atherothrombotic event. This has been facilitated using intravascular ultrasound, optical coherence tomography, and near-infrared spectroscopy in the clinical settings to achieve surrogate end points. These techniques are now providing exquisite information on plaque size, composition, lipid volume, fibrous cap thickness and other features that were previously not possible with conventional angiography.
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