Non-statin lipid lowering and coronary plaque composition

Abstract

Cardiovascular disease (CVD) is the leading cause of death in the United States with coronary artery disease (CAD) accounting for more than 40% of CVD deaths. 1 Benjamin E.J. Virani S.S. Callaway C.W. et al. Heart disease and stroke statistics-2018 update: a report from the American heart association. Circulation. 2018; 137: e67-e492 Crossref PubMed Scopus (4417) Google Scholar As our understanding of the pathogenesis of CAD has evolved, it is now apparent that there can be significant inter-person heterogeneity in the progression of coronary atherosclerosis and development of obstructive coronary disease. 2 Libby P. Theroux P. Pathophysiology of coronary artery disease. Circulation. 2005; 111: 3481-3488 Crossref PubMed Scopus (1254) Google Scholar The composition of individual coronary artery plaques has substantial variation and differing proportions of fibrosis, lipid, calcium, and/or necrotic core. 3 Fayad Z.A. Fuster V. Clinical imaging of the high-risk or vulnerable atherosclerotic plaque. Circ Res. 2001; 89: 305-316 Crossref PubMed Scopus (455) Google Scholar Differences in plaque composition along with specific plaque features such as thin or thick caps 2 Libby P. Theroux P. Pathophysiology of coronary artery disease. Circulation. 2005; 111: 3481-3488 Crossref PubMed Scopus (1254) Google Scholar can also portend different risks for acute coronary syndrome 3 Fayad Z.A. Fuster V. Clinical imaging of the high-risk or vulnerable atherosclerotic plaque. Circ Res. 2001; 89: 305-316 Crossref PubMed Scopus (455) Google Scholar , 4 Insull Jr., W. The pathology of atherosclerosis: plaque development and plaque responses to medical treatment. Am J Med. 2009; 122: S3-S14 Abstract Full Text Full Text PDF PubMed Scopus (379) Google Scholar . Importantly, the composition of plaques is not static and they can progress, regress, or alter in composition, although this pathophysiology is still not fully understood. 4 Insull Jr., W. The pathology of atherosclerosis: plaque development and plaque responses to medical treatment. Am J Med. 2009; 122: S3-S14 Abstract Full Text Full Text PDF PubMed Scopus (379) Google Scholar Multiple non-invasive methods to investigate plaque composition and metabolic activity now exist, which include intravascular ultrasound (IVUS), coronary computed tomography angiography (CTA), and positron emission tomography (PET). This has allowed for the study of in vivo changes with increasing granularity and, among these imaging modalities, coronary CTA is uniquely suited to describe plaque composition throughout the entire coronary tree.