40 -5 (67) 2024 - Alieva R.B., Shek A.B. - VARIABLE IMAGE OF ATHEROSCLEROSIS

VARIABLE IMAGE OF ATHEROSCLEROSIS

Alieva R.B. - Republican Specialized Scientific Practical Medical Center of Neurosurgery (RSSPMCN), Tashkent

Shek A.B. - Republican Specialized Scientific Practical Medical Center of Neurosurgery (RSSPMCN), Tashkent

Resume

Emerging evidence has spurred a considerable evolution of concepts relating to atherosclerosis, and has called into question many previous notions. Here I review this evidence, and discuss its implications for understanding of atherosclerosis. The risk of developing atherosclerosis is no longer concentrated in Western countries, and it is instead involved in the majority of deaths worldwide. Atherosclerosis now affects younger people, and more women and individuals from a diverse range of ethnic backgrounds, than was formerly the case. The risk factor profile has shifted as levels of low-density lipoprotein (LDL) cholesterol, blood pressure and smoking have decreased. Recent research has challenged the protective effects of high-density lipoprotein, and now focuses on triglyceride-rich lipoproteins in addition to low-density lipoprotein as causal in atherosclerosis. Non-traditional drivers of atherosclerosis—such as disturbed sleep, physical inactivity, the microbiome, air pollution and environmental stress—have also gained attention. Inflammatory pathways and leukocytes link traditional and emerging risk factors alike to the altered behaviour of arterial wall cells. Probing the pathogenesis of atherosclerosis has highlighted the role of the bone marrow: somatic mutations in stem cells can cause clonal haematopoiesis, which represents a previously unrecognized but common and potent age-related contributor to the risk of developing cardiovascular disease. Characterizations of the mechanisms that underpin thrombotic complications of atherosclerosis have evolved beyond the ‘vulnerable plaque’ concept. These advances in our understanding of the biology of atherosclerosis have opened avenues to therapeutic interventions that promise to improve the prevention and treatment of now-ubiquitous atherosclerotic diseases.

Keywords: atherosclerotic cardiovascular diseases, risk factors, coronary heart disease, lipids, statins.

First page

230

Last page

248

For citation: Alieva R.B., Shek A.B. - VARIABLE IMAGE OF ATHEROSCLEROSIS//New Day in Medicine 5(67)2024 230-248 https://newdayworldmedicine.com/en/article/3758

List of References

  1. Gaziano, T. A., Prabhakaran, D. Gaziano, J. M. in Braunwald’s Heart Disease (eds Zipes, D. P. et al.) 1–18 (Saunders, 2018).
  2. Dai, H. et al. Global, regional, and national burden of ischemic heart disease and its attributable risk factors, 1990-2017: results from the global Burden of Disease Study 2017. Eur. Heart J. Qual. Care Clin. Outcomes, https://doi.org/10.1093/ehjqcco/qcaa076 (2020).
  3. Libby, P. et al. Atherosclerosis. Nat. Rev. Dis. Primers 5, 56 (2019).
  4. Virani, S. S. et al. Heart disease and stroke statistics—2021 update: a report from the American Heart Association. Circulation 143, e254–e743 (2021).
  5. Arora, S. et al. Twenty year trends and sex differences in young adults hospitalized with acute myocardial infarction. Circulation 139, 1047–1056 (2019).
  6. Towfighi, A., Markovic, D. & Ovbiagele, B. National gender-specific trends in myocardial infarction hospitalization rates among patients aged 35 to 64 years. Am. J. Cardiol. 108, 1102–1107 (2011).
  7. Blüher, M. Obesity: global epidemiology and pathogenesis. Nat. Rev. Endocrinol. 15, 288–298 (2019).
  8. Roth, G. A. et al. Global burden of cardiovascular diseases and risk factors, 1990–2019: update from the GBD 2019 study. J. Am. Coll. Cardiol. 76, 2982–3021 (2020). This compilation provides recent data regarding cardiovascular risk factors in various regions of the world, and their import for cardiovascular diseases
  9. Després, J.-P. Lemieux, I. Abdominal obesity and metabolic syndrome. Nature 444, 881–887 (2006).
  10. Nordestgaard, B. G. Varbo, A. Triglycerides and cardiovascular disease. Lancet 384, 626–635 (2014).
  11. Moore, J. X., Chaudhary, N. & Akinyemiju, T. Metabolic syndrome prevalence by race/ethnicity and sex in the United States, national health and nutrition examination survey, 1988–2012. Prev. Chronic Dis. 14, E24 (2017).
  12. Ference, B. A. et al. Low-density lipoproteins cause atherosclerotic cardiovascular disease. 1. Evidence from genetic, epidemiologic, and clinical studies. A consensus statement from the European Atherosclerosis Society Consensus Panel. Eur. Heart J. 38, 2459–2472 (2017).
  13. Borén, J. et al. Low-density lipoproteins cause atherosclerotic cardiovascular disease: pathophysiological, genetic, and therapeutic insights: a consensus statement from the European Atherosclerosis Society Consensus Panel. Eur. Heart J. 41, 2313–2330 (2020).
  14. Goldstein, J. L. & Brown, M. S. A century of cholesterol and coronaries: from plaques to genes to statins. Cell 161, 161–172 (2015). A review of the involvement of LDL in atherosclerosis, which represents one of the major advances in cardiovascular science in the past century.
  15. Domanski, M. J. et al. Time course of LDL cholesterol exposure and cardiovascular disease event risk. J. Am. Coll. Cardiol. 76, 1507–1516 (2020).
  16. Ridker, P. M. How common is residual inflammatory risk? Circ. Res. 120, 617–619 (2017).
  17. Sabatine, M. S. et al. Evolocumab and clinical outcomes in patients with cardiovascular disease. N. Engl. J. Med. 376, 1713–1722 (2017).
  18. Schwartz, G. G. et al. Alirocumab and cardiovascular outcomes after acute coronary syndrome. N. Engl. J. Med. 379, 2097–2107 (2018).
  19. Kwok, C. S. et al. Unplanned hospital readmissions after acute myocardial infarction: a nationwide analysis of rates, trends, predictors and causes in the United States between 2010 and 2014. Coron. Artery Dis. 31, 354–364 (2020).
  20. Brook, R. D., Newby, D. E. Rajagopalan, S. Air pollution and cardiometabolic disease: an update and call for clinical trials. Am. J. Hypertens. 31, 1–10 (2018).

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