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Atherosclerosis causes myocardial infarction, ischaemic cardiomyopathy, many ischaemic strokes and jeopardized limbs. Despite enormous progress, atherosclerosis has become the major cause of death worldwide. This Comment intertwines clinical and basic advances in atherosclerosis to illustrate their interdependence, which provides a template for a way forwards to conquer the scourge of atherosclerotic cardiovascular disease.
Dietary supplementation with NAD+ precursors or ketone esters has been shown to improve mitochondrial function in preclinical models of heart failure with either reduced or preserved ejection fraction. Both supplementation approaches hold promise but are in the early stages of development as clinical therapies for heart failure.
A new study now shows that basophils can influence cardiac remodelling after myocardial infarction. Despite their low number in the injured myocardium, basophils strongly affected other immune cells involved in cardiac repair and remodelling in mice, promoting cardiac healing by facilitating the polarization of reparative macrophages.
High levels of extracellular glucose induce trained immunity in macrophages, promoting a pro-atherosclerotic phenotype that persists even after normalization of glucose levels.
Dyslipidaemias, particularly hypercholesterolaemia, are major risk factors for cardiovascular disease. In this Review, Catapano and colleagues summarize the latest data on plasma lipid levels and associated deaths and trends in these parameters over the past four decades in different regions of the world.
The metabolism of lipids accumulated in blood vessel walls and the heart produces sphingolipids, such as ceramides, which are associated with the development of diabetes mellitus, atherosclerosis, hypertension and heart failure. In this Review, the authors discuss ceramides as drivers of cardiovascular disease and therapeutic strategies to lower plasma and cardiac levels of ceramides.
In this Review, Gotto and colleagues summarize the evolution of our understanding of HDL structure and function, current models of atheroprotection by HDL involving reverse cholesterol transport, and their identification of a correlation between the bioavailability of free cholesterol contained in HDL and atherogenesis.
Atherosclerotic plaque erosion is becoming an increasingly common characteristic of culprit lesions in acute coronary syndromes. In this Review, Fahed and Jang discuss the patient phenotype and the molecular characteristics in plaque erosion and provide their vision for a potential major shift in the management of patients with plaque erosion.
