Atherosclerosis, neoatherosclerosis, and vascular disease.

Abstract

Download the Issue @ a Glance podcast Subscribe to the EHJ Podcast ![Graphic][1] Geoffrey Rose (1926–1993) pioneered the concept that, to reduce the burden of disease, improving the population distribution of a risk factor was preferable to interventions that target high-risk individuals.1 This strategy has become commonplace today and the basis of many guidelines.2–4 To strengthen this approach, the European Society of Cardiology has thus established the Geoffrey Rose Lecture on prevention at their annual congress. One of the recent awardees was Veronique L. Roger from the Mayo Clinic in Rochester, Minnesota USA. In her Clinical Review ‘ Cardiovascular diseases in populations: secular trends and contemporary challenges ’5, she reflects on this concept and examines if temporal trends in the burden of cardiovascular disease, in particular myocardial infarction and heart failure, support that hypothesis. Patients with coronary artery disease and myocardial infarction, still the most important form of cardiovascular disease,6 are commonly treated with balloon angioplasty and stents or bypass surgery, depending on the coronary anatomy and the SYNTAX score, and on the decision reached in the HeartTeam.7,8 Despite the reduction in late thrombotic events with newer generation drug-eluting stents,9 late stent failure remains a concern following stent placement. This issue continues with a Clinical Review manuscript entitled ‘ Neoatherosclerosis: overview of histopathological findings and implications for intravascular imaging assessment ’ by Michael Joner from CVPath Institute Inc. in Gaithersburg, Maryland, USA.10 In-stent neoatherosclerosis has emerged as an important contributing factor to late vascular complications including very late stent thrombosis and late in-stent restenosis. Histologically, neoatherosclerosis is characterized by accumulation of lipid-laden foamy macrophages within the neointima with or without necrotic core formation and/or calcification. The development of neoatherosclerosis may occur in months to years following stent placement, whereas … [1]: /embed/inline-graphic-1.gif