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[New treatment strategies in coronary disease]
1Institut de cardiologie de Montréal.
Insights
Coronary atherosclerosis mortality has declined due to better risk factor management and therapies. Interventions like lifestyle changes and medications can delay disease progression and reduce morbidity and mortality.
Area of Science:
- Cardiovascular Medicine
- Atherosclerosis Research
Context:
- Coronary atherosclerosis remains a significant public health issue, despite a 30-40% decrease in mortality.
- Disease incidence and prevalence may not have significantly declined, indicating a need for further intervention.
Purpose:
- To review recent studies on interventions that delay coronary atherosclerosis progression and promote regression.
- To explore various therapeutic strategies, including lifestyle modifications, lipid-lowering agents, and pharmacologic treatments.
Summary:
- Studies show that lifestyle changes, hypocholesterolemic agents, and partial ileal bypass can lower LDL or raise HDL cholesterol, leading to delayed progression or regression of coronary atherosclerosis.
- Other interventions like specific protein/enzyme inhibitors, antioxidants, omega-3 fatty acids, calcium antagonists, and angiotensin-converting-enzyme inhibitors also show promise.
- These interventions not only affect plaque size but can also preserve endothelial cell integrity and function.
Impact:
- Delayed progression and regression of coronary atherosclerosis can lead to reduced morbidity and mortality.
- Interventions targeting lipid profiles and endothelial function offer new avenues for managing cardiovascular disease.
- Further research into these interventions can optimize cardiovascular health outcomes.
Abstract:
The mortality associated with coronary atherosclerosis has decreased by 30% to 40% in the last few decades. This reduction has followed major pharmacological and biotechnological advances and can possibly be attributed to better management of risk factors for coronary atherosclerosis and to more effective therapy of its late manifestations. Nevertheless, the coronary artery disease remains a major public health problem. It is responsible for 40% to 45% of deaths in our population and, although it becomes manifest later than previously, its incidence and prevalence may not have declined significantly. Recent studies suggest that progression of coronary atherosclerosis can be delayed, that regression can also occur, and that this can lead to a reduction in morbidity and mortality. Several types of interventions have been performed in these studies. Some of them such as a drastic modification in lifestyle, the administration of one or several hypocholesterolemic agents or partial ileal bypass have achieved these results by markedly lowering LDL or raising HDL cholesterol. Other manipulations of plasma lipoproteins are also possible, such as the administration of specific protein or enzyme inhibitors, anti-oxidants and omega-3 fatty acids. Calcium antagonists and possibly angiotensin converting-enzyme inhibitors slow the progression of early coronary lesions and prevent the appearance of new lesions. These interventions, in addition to influencing the size of the atherosclerotic plaque, can have other important effects. They can contribute to the preservation of integrity and function of endothelial cells.(ABSTRACT TRUNCATED AT 250 WORDS)