Interventional strategies in early atherosclerosis

Abstract

Atherosclerosis remains clinically mute for a long time and frequently manifests itself with an acute cardiovascular event; therefore, the possibility to detect the disease in a subclinical phase and to reduce or reverse its progression is an issue of relevance. Non-invasive diagnostic procedures such as B-mode ultrasonography of carotid intima-media thickness (CIMT), electron beam computed tomography (EBCT) and magnetic resonance angiography (MRA) allow to identify atherosclerotic disease in its early phases, to evaluate the disease progression and monitor the effects of interventions. In recent years, several therapeutic strategies have been adopted over time to slow early atherosclerosis in asymptomatic individuals at intermediate/high cardiovascular risk. Prospective trials employing multifactorial non-pharmacological interventions (diet, exercise, smoking cessation) have demonstrated a favorable effect on progression of atherosclerosis. Hence lifestyle modification may be an effective therapeutic strategy to be adopted as a first step and a highly cost-effective intervention in a preclinical setting involving a large number of individuals. Drugs should be considered as a second step or should be associated to further reduce the risk in individuals at high probability of future events, who require more intensive interventions. Reducing low-density lipoprotein levels, blood pressure and platelet aggregation seems to be the most effective intervention in these subjects, whereas the treatment of emerging coronary risk factors, e.g. oxidative stress, inflammatory activation and infections has not produced the expected protective effect.