Abstract

Lipid management remains the mainstay of cardiovascular disease prevention. Drugs that target cholesterol reduction, such as HMG-CoA reductase inhibitors (statins) and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, have shown significant mortality and morbidity benefit. Predominantly targeting low-density lipoprotein (LDL). These drugs have been indicated to reduce lipid composition and plaque proliferation. Total plaque burden and composition can now be assessed with noninvasive advanced cardiac imaging modalities. This chapter will address the components of atherosclerotic plaque as identified with coronary computed tomography angiography (CCTA) and review in detail the changes in plaque characteristics that may be responsible for reduction in cardiac events. These changes in plaque composition may help guide future management of cardiovascular disease, serving as an imaging biomarker for better risk stratification. Readers will gain a deeper understanding of plaque morphology with direct clinical applicability as well as an understanding of how noninvasive imaging can be utilized to assess plaque composition.

Highlights

  • Cardiovascular disease (CVD) has remained the leading cause of death in the United States in 2018 [1]

  • Cardiac imaging is mainly performed via intravascular ultrasound (IVUS), optical coherence tomography (OCT), and coronary computed tomography angiography (CCTA)

  • Noninvasive imaging modalities such optical coherence tomography (OCT), intravascular ultrasound (IVUS), and coronary computed tomography angiography (CCTA) have the ability to characterize plaque based on the above pathophysiology and define high risk features that in turn increase risk of cardiovascular events [8]

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Summary

Introduction

Cardiovascular disease (CVD) has remained the leading cause of death in the United States in 2018 [1]. Atherosclerosis is the leading factor in causing cardiovascular death. The main factors that drive atherosclerosis are LDL cholesterol, hypertension, diabetes, and smoking [2]. The United Stated Preventive Services Task Force recommends screening everyone who are at risk for coronary artery disease, all men over age 35 and all women over age 45. Treatment options can be aided by cardiac imaging. Cardiac imaging is mainly performed via intravascular ultrasound (IVUS), optical coherence tomography (OCT), and coronary computed tomography angiography (CCTA). This development has made plaque characterization possible. Categories of plaque are placed into 4 broad categories: low-attenuating, fibrofatty, fibrocalcified, and densely calcified plaque [4]

Pathophysiology of atherosclerosis
Plaque characterization by noninvasive imaging
Statins
Effects of EPA on atherosclerotic plaque via CCTA
Effects of PCSK9 inhibitors on atherosclerotic plaque via CCTA
Future directions
Findings
Conclusion

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