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  • Review Article
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Update on advances in atherothrombosis

Nature Clinical Practice Cardiovascular Medicine volume 4, pages 78–89 (2007)Cite this article

Abstract

The study of atherothrombosis is a rapidly evolving field, and significant progress was achieved in various aspects of the disease during the past year. In the area of diagnostic imaging, MRI and multidetector CT were actively used to evaluate the characteristics of the arterial wall, including calcified and noncalcified lesions, and both in the coronary and extracoronary vascular territories. There was also extensive research into the application of imaging modalities to visualize cellular or molecular disease processes, known as molecular imaging. Considerable efforts were devoted to the identification of novel biomarkers that reflect different components of atherothrombosis, namely inflammation, thrombogenicity, oxidative stress and reparative ability, predicting the presence of early disease or the risk of clinical events. In the therapeutic arena, substantial evidence accumulated on the beneficial effects of several pharmacologic agents, most significantly statins. Finally, important advances were also made in the understanding of the roles of immunity and neovascularization in atherogenesis, including the development and progression of disease at different stages. Awareness of these recent advances and new lines of active research is fundamental for health professionals involved in the care of patients with atherothrombosis. In this Review we present an overview of data in these areas.

Key Points

  • Noninvasive coronary angiography in clinical practice can be performed with high accuracy in selected populations. MDCT is currently the modality of choice

  • Whole-body MRI coupled with vessel wall and molecular imaging promises to enable a comprehensive evaluation of the arterial system in one single examination, providing indices of burden of disease and plaque vulnerability

  • Apart from traditional risk factors, which account for a large proportion of cardiovascular risk, novel biomarkers of inflammation, procoagulability and oxidative stress provide additive prognostic information

  • Endogenous reparative mechanisms involving progenitor cells have an important role in cardiovascular homeostasis, and stem cell profile might be related to susceptibility of disease

  • Statin therapy to reduce LDL cholesterol below previously recommended levels provides increased cardiovascular protection, which could be partly mediated through anti-inflammatory actions. Augmentation of HDL cholesterol levels seems to be the next major therapeutic target

  • Further understanding of the mechanisms and significance of plaque neovascularization and immune modulation in atherogenesis could lead to improved tools for risk stratification and therapy of atherothrombosis

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Figure 1: 'Whole-heart' magnetic resonance angiography showing normal coronary arteries.
Figure 2: Molecular MRI of experimentally induced carotid thrombosis in a rabbit model.
Figure 3: Pooled estimation of the percentage of hard coronary events to occur during the next 10 years in men and women of different age groups in the US.
Figure 4: Differences in the cumulative incidence of major cardiovascular events in the Treating to New Targets (TNT) trial.
Figure 5: Activation of hypoxia inducible factor (HIF)1-α and its contribution to angiogenesis.
Figure 6: Role of coordinated angiogenesis and inflammation in plaque progression.

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Authors and Affiliations

  1. J Sanz is Assistant Professor in Medicine/Cardiology, PR Moreno is the Director of Interventional Cardiology Research and Associate Professor of Medicine, and V Fuster is Director of the Zena and Michael A Wiener Cardiovascular Institute and the Marie-Josée and Henry R Kravis Center for Cardiovascular Health, Mount Sinai Medical Center, New York, NY, USA.,

    Javier Sanz, Pedro R Moreno & Valentin Fuster

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  1. Javier Sanz
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Correspondence to Valentin Fuster.

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Sanz, J., Moreno, P. & Fuster, V. Update on advances in atherothrombosis. Nat Rev Cardiol 4, 78–89 (2007). https://doi.org/10.1038/ncpcardio0774

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