Advancements in risk stratification and management strategies in primary cardiovascular prevention.

Autor: Barkas F; Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece. Electronic address: f.barkas@uoi.gr., Sener YZ; Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey., Golforoush PA; The Hatter Cardiovascular Institute, University College London, London, United Kingdom., Kheirkhah A; Institute of Genetic Epidemiology, Medical University of Innsbruck, Innsbruck, Austria., Rodriguez-Sanchez E; Division of Cardiology, Department of Medicine, Department of Physiology, and Molecular Biology Institute, UCLA, Los Angeles, CA, USA., Novak J; 2(nd) Department of Internal Medicine, St. Anne's University Hospital in Brno and Faculty of Medicine of Masaryk University, Brno, Czech Republic; Department of Physiology, Faculty of Medicine, Masaryk University, Brno, Czech Republic., Apellaniz-Ruiz M; Genomics Medicine Unit, Navarra Institute for Health Research - IdiSNA, Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), Pamplona, Spain., Akyea RK; Centre for Academic Primary Care, School of Medicine, University of Nottingham, United Kingdom., Bianconi V; Department of Medicine and Surgery, University of Perugia, Italy., Ceasovschih A; Internal Medicine Department, Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania., Chee YJ; Department of Endocrinology, Tan Tock Seng Hospital, Singapore., Cherska M; Cardiology Department, Institute of Endocrinology and Metabolism, Kyiv, Ukraine., Chora JR; Unidade I&D, Grupo de Investigação Cardiovascular, Departamento de Promoção da Saúde e Doenças Não Transmissíveis, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal; Universidade de Lisboa, Faculdade de Ciências, BioISI - Biosystems & Integrative Sciences Institute, Lisboa, Portugal., D'Oria M; Division of Vascular and Endovascular Surgery, Department of Medical Surgical and Health Sciences, University of Trieste, Trieste, Italy., Demikhova N; Sumy State University, Sumy, Ukraine; Tallinn University of Technology, Tallinn, Estonia., Kocyigit Burunkaya D; Cardiology Clinic, Ankara Bilkent City Hospital, Ankara, Turkey., Rimbert A; Nantes Université, CNRS, INSERM, l'institut du Thorax, Nantes, France., Macchi C; Department of Pharmacological and Biomolecular Sciences 'Rodolfo Paoletti', Università Degli Studi di Milano, Milan, Italy., Rathod K; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom; Barts Interventional Group, Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom., Roth L; Laboratory of Physiopharmacology, University of Antwerp, Antwerp, Belgium., Sukhorukov V; Laboratory of Cellular and Molecular Pathology of Cardiovascular System, Petrovsky National Research Centre of Surgery, Moscow, Russia., Stoica S; 'Victor Babes' University of Medicine and Pharmacy, Timisoara, Romania; Institute of Cardiovascular Diseases Timisoara, Timisoara, Romania., Scicali R; Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy., Storozhenko T; Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium; Department of Prevention and Treatment of Emergency Conditions, L.T. Malaya Therapy National Institute NAMSU, Kharkiv, Ukraine., Uzokov J; Republican Specialized Scientific Practical Medical Center of Therapy and Medical Rehabilitation, Tashkent, Uzbekistan., Lupo MG; Department of Medicine, University of Padova, Italy., van der Vorst EPC; Institute for Molecular Cardiovascular Research (IMCAR), RWTH Aachen University, 52074, Aachen, Germany; Aachen-Maastricht Institute for CardioRenal Disease (AMICARE), RWTH Aachen University, 52074, Aachen, Germany; Institute for Cardiovascular Prevention (IPEK), Ludwig-Maximilians-University Munich, 80336, Munich, Germany; Interdisciplinary Center for Clinical Research (IZKF), RWTH Aachen University, 52074, Aachen, Germany., Porsch F; Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria.
Jazyk: angličtina
Zdroj: Atherosclerosis [Atherosclerosis] 2024 Aug; Vol. 395, pp. 117579. Date of Electronic Publication: 2024 May 15.
DOI: 10.1016/j.atherosclerosis.2024.117579
Abstrakt: Atherosclerotic cardiovascular disease (ASCVD) remains a leading cause of morbidity and mortality worldwide, highlighting the urgent need for advancements in risk assessment and management strategies. Although significant progress has been made recently, identifying and managing apparently healthy individuals at a higher risk of developing atherosclerosis and those with subclinical atherosclerosis still poses significant challenges. Traditional risk assessment tools have limitations in accurately predicting future events and fail to encompass the complexity of the atherosclerosis trajectory. In this review, we describe novel approaches in biomarkers, genetics, advanced imaging techniques, and artificial intelligence that have emerged to address this gap. Moreover, polygenic risk scores and imaging modalities such as coronary artery calcium scoring, and coronary computed tomography angiography offer promising avenues for enhancing primary cardiovascular risk stratification and personalised intervention strategies. On the other hand, interventions aiming against atherosclerosis development or promoting plaque regression have gained attention in primary ASCVD prevention. Therefore, the potential role of drugs like statins, ezetimibe, proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, omega-3 fatty acids, antihypertensive agents, as well as glucose-lowering and anti-inflammatory drugs are also discussed. Since findings regarding the efficacy of these interventions vary, further research is still required to elucidate their mechanisms of action, optimize treatment regimens, and determine their long-term effects on ASCVD outcomes. In conclusion, advancements in strategies addressing atherosclerosis prevention and plaque regression present promising avenues for enhancing primary ASCVD prevention through personalised approaches tailored to individual risk profiles. Nevertheless, ongoing research efforts are imperative to refine these strategies further and maximise their effectiveness in safeguarding cardiovascular health.
Competing Interests: Declaration of competing interest F.B. has received honoraria and grants from Novartis, Novo Nordisk, Sanofi, and Viatris, outside the scope of the submitted work. All other authors declare to have no conflict of interest.
(Copyright © 2024 Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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