Viewpoint and Commentary
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Curing Atherosclerosis Should Be the Next Major Cardiovascular Prevention Goal

https://doi.org/10.1016/j.jacc.2014.04.009Get rights and content
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Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death in developed and developing countries. Despite decades of effort, unhealthy lifestyle habits and ASCVD risk factor levels remain high and are increasing in many population groups. A new approach to ASCVD prevention is needed. Multiple lines of evidence from animal and human studies suggest that atherosclerosis regression and normalization of vessel function can occur when low-density lipoprotein cholesterol (LDL-C) lowering occurs early in the course of atherosclerosis or when very aggressive LDL-C lowering occurs somewhat later. We propose a new paradigm focused on curing atherosclerosis early in the course of the disease. An approach that resets the vascular aging clock composed of initial regression therapy followed by periodic retreatment to suppress atherosclerosis development may be possible, with the ultimate goal of preventing subsequent ASCVD events. Proof-of-concept studies are needed to determine: 1) the optimal age and/or extent of atherosclerosis for intervention and LDL-C–lowering therapy; 2) the intensity and duration of therapy for inducing atherosclerosis regression; and 3) documenting the normalization of vascular function. Ultimately, this new paradigm will need to be evaluated in ASCVD outcomes trials.

Key Words

atherosclerosis
primordial prevention
regression

Abbreviations and Acronyms

ASCVD
atherosclerotic cardiovascular disease
CHD
coronary heart disease
CIMT
carotid intimal medial thickness
CVD
cardiovascular disease
FH
familial hypercholesterolemia
HDL-C
high density lipoprotein cholesterol
LDL-C
low-density lipoprotein cholesterol
PCSK-9
proprotein convertase subtilisin/kexin type 9

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Dr. Robinson has received research grants to her institution from Amarin, Amgen, AstraZeneca, Daiichi-Sankyo, Eli Lilly, Esperion, Genentech/Hoffmann-La Roche, GlaxoSmithKline, Merck, Pfizer, Regeneron/Sanofi, and Zinfandel/Takeda; and is a consultant for Amgen, Hoffmann-LaRoche, Pfizer, and Regeneron/Sanofi. Dr. Gidding has received a research grant from GlaxoSmithKline.