Imaging subclinical atherosclerosis promises better cardiovascular primary prevention

Abstract

Cardiovascular disease (CVD) remains a leading cause of morbidity and mortality worldwide with enormous social and economic cost implications. The ideal strategy for altering such a trend is optimum primary prevention. The European Society of Cardiology (ESC) guidelines 1 and recent American Heart Association/ American College of Cardiology (AHA/ACC) guidelines for CVD prevention 2 stress the central role of promoting a healthy lifestyle throughout life. The two guidelines recommend assessing conventional cardiovascular risk factors and calculate the 10-year risk of fatal CVD or 10-year probability of developing a first major cardiovascular event (myocardial infarction or stroke) by using the risk charts or scores. However, the benefit of using current CVD risk estimation models is limited. The use of the available tools, such as the SCORE of the ESC, may lead to serious underor over-estimation of cardiovascular risk, particularly in asymptomatic subjects considered at intermediate risk for events. Also, selected groups, such as young people and women, require special consideration for risk stratification. 3 Based on this, the ESC guidelines for CVD prevention proposed other factors that should be considered in order to better classify individuals into more appropriate risk categories. Among these factors is the search for objective evidence for subclinical atherosclerosis, such as coronary calcification and its score obtained by computed tomography (CT) or atherosclerotic plaque detection and measurements obtained from carotid artery ultrasound scans.Coronary artery scanning performed using cardiac CT and calculation of the Agatston calcium score is the most commonly used technique in clinical practice for detection of subclinical atherosclerosis, prognostic stratification of asymptomatic individuals and implementation of preventive strategies. Furthermore, like a coronary calcium score, a routine echocardiographic examination may offer an indirect evaluation of subclinical atherosclerosis disease by semi-quantitative assessment of cardiac calcifications at different sites, including the mitral apparatus (annulus, leaflets and papillary muscles), aortic valve and ascending aorta, that have been shown to predict future major coronary events, major cardiovascular events and mortality in asymptomatic subjects. 4,5 The Multi-Ethnic Study of Atherosclerosis, a population-based cohort with no known cardiovascular disease, reported the accuracy of coronary artery calcium score in predicting clinical events. A calcium score greater than 300 accurately identified subjects at high risk for future coronary heart disease events, with a hazard ratio of nearly 10. 6,7 Likewise, visualization of asymptomatic subclinical carotid atherosclerosis can improve an individual's risk classification and consequently guide towards a tailored optimum prevention strategy, one of the most important being lipid lowering therapy, and the eligibility for statin therapy. In 'The BioImage Study ', 8 Mortensen et al. proposed a personalized ap...

Rational Design of a Double-Locked Photoacoustic Probe for Precise In Vivo Imaging of Cathepsin B in Atherosclerotic Plaques

“…It triggers inflammation, leading to cytokine release, oxidative stress, and increased risk of plaque rupture, heart attack, and stroke. Thus, close monitoring and management of cardiovascular risk factors during acute pneumonia is crucial. ,, Specifically, ApoE –/– mice were fed on a high-fat diet for 14 weeks to obtain AS mice. To obtain the AS mice complicated with the pneumonia model, AS mice received 50 μg of LPS intranasally twice a week ( n = 3) (Figure g).…”

“…Atherosclerosis (AS) is the primary cause of cardiovascular disease, which can lead to clinical complications such as myocardial infarction and stroke. − Despite advances in diagnosis and therapy, cardiovascular disease remains the leading cause of death worldwide. , AS is a chronic disease characterized by lipid-laden plaque formation within arterial walls. , Plaques can remain asymptomatic for prolonged periods but may suddenly rupture, causing thrombus formation and acute events . Atherosclerotic plaque rupture associated with inflammation has been correlated with highly activated macrophages that contain and secrete proteolytic enzymes mediating vulnerable plaque erosion and rupture. − Among these enzymes, cathepsin B (CTB), a typical protease, is highly expressed in biologically active macrophages and contributes to lysosomal dysfunction, abnormal lipid metabolism, and vascular inflammation. , Abnormally elevated CTB activity can disturb the structural integrity of vulnerable plaques and provoke plaque rupture, exposing the lipid-laden plaque interior to thrombin-activating blood cascades .…”

From risk communication about asymptomatic atherosclerosis to cognitive and emotional reactions and lifestyle modification

“…Evidence is building up regarding the advantage of sharing arterial imaging evidence of subclinical atherosclerosis with asymptomatic individuals as a way of improving risk control and clinical outcomes [ 27 ]. Atherosclerosis screening with ultrasound, which is non-invasive and cost effective, and therefore enables screening of populations [ 28 , 29 ], can be used as part of CVD risk communication [ 30 ].…”