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Management of Atherosclerosis
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Management of Atherosclerosis

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: 28 February 2025 | Viewed by 8782

Special Issue Editor

Dr. Luca Di Vito

E-Mail Website
Guest Editor
Cardiology Unit, C. and G. Mazzoni Hospital, AST Ascoli Piceno, Ascoli Piceno, Italy
Interests: coronary heart disease; heart failure; heart disease; preventive cardiology; cardiovascular epidemiology

Special Issue Information

Dear Colleagues,

Although we are living in the era of general guidelines for the management of coronary artery disease patients, the tailored medicine approach is promising greater interest among physicians. Thus, understanding the different pathophysiological mechanisms that are at the basis of atherosclerosis is the key to precise medicine. In addition, not all acute plaque destabilizations exert symptoms. Indeed, most of the plaque rupture or erosion events occur without overt clinical signs, favoring plaque growth. The management of its residual risk remains a cornerstone in this field of research.

Non-invasive imaging techniques such as stress echocardiography and, more recently, myocardial strain evaluation allow for the early identification of patients with subclinical atherosclerosis and the stratification their residual risk. Coronary computed tomography angiography is also attracting a greater level of interest for plaque characterization and perivascular inflammation detection.

We are also in the age of novel LDL cholesterol treatments that dramatically reduce the rate of recurrent coronary events. However, the role of other lipoproteins in atherosclerosis, their management, and current predictors of recurrent coronary events remain to be investigated.  

Atherosclerosis may also present with micro-vessel dysfunction instead of significant epicardial vessel obstruction. The management of patients with myocardial infarction without obstructive coronary artery disease deserves tailored treatments.

Finally, even systemic diseases affecting other organs than the heart may impact the development and progression of both coronary plaque and endothelial dysfunction. These patients require specific treatment and an integrated approach.

This Special Issue, titled “Management of Atherosclerosis”, will focus on atherosclerosis progression, diagnostic techniques, and the current treatments that are available for this disease. To this end, state-of-the-art reviews as well as original research articles, focused on the pathophysiology and management of atherosclerosis, will be warmly welcomed.

Dr. Luca Di Vito
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • plaque erosion
  • plaque rupture
  • myocardial strain
  • coronary computed tomography angiography
  • MINOCA
  • recurrent coronary events
  • PCSK9 inhibitors
  • inclisiran
  • microvascular dysfunction

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Published Papers (4 papers)

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Research

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15 pages, 1340 KiB  
Article
Gene Mutation in Patients with Familial Hypercholesterolemia and Response to Alirocumab Treatment—A Single-Centre Analysis
by Joanna Rogozik, Jakub Kosma Rokicki, Marcin Grabowski and Renata Główczyńska
J. Clin. Med. 2024, 13(18), 5615; https://doi.org/10.3390/jcm13185615 - 22 Sep 2024
Viewed by 1344
Abstract
Background: Familial hypercholesterolemia (FH) is an autosomal dominant genetic disorder characterized by significantly elevated levels of low-density lipoprotein (LDL) cholesterol, which plays a major role in the progression of atherosclerosis and leads to a heightened risk of premature atherosclerotic cardiovascular disease. Methods [...] Read more.
Background: Familial hypercholesterolemia (FH) is an autosomal dominant genetic disorder characterized by significantly elevated levels of low-density lipoprotein (LDL) cholesterol, which plays a major role in the progression of atherosclerosis and leads to a heightened risk of premature atherosclerotic cardiovascular disease. Methods: We have carried out an observational study on a group of 17 patients treated at the Outpatient Lipid Clinic from 2019 to 2024. Result: The most frequent mutation observed was found in the LDL receptor (LDLR) gene, which was identified in ten patients (58.8%). Five patients were identified to have a mutation in the apolipoprotein B (APOB) gene, whereas two patients had two points mutations, one in the LDLR, and the other in the APOB gene. The average age of patients with LDLR mutation was 54.8 (12.3); for APOB mutation it was 61.4 (9.3) and for patients with two points mutation it was 61.5 (14.8). The study results showed that at Week 12, individuals with LDLR-defective heterozygotes who were given alirocumab 150 mg every two weeks experienced a 63.0% reduction in LDL cholesterol levels. On the other hand, individuals with APOB heterozygotes experienced a 59% reduction in LDL cholesterol levels. However, in patients with double heterozygous for mutations in LDLR and APOB genes, there was a hyporesponsiveness to alirocumab, and the reduction in LDL-C was only by 23% in two individuals. Conclusions: In patients with a single mutation, there was a greater response to treatment with alirocumab in contrast to patients with double heterozygous mutation, who did not respond to treatment with PCSK9 inhibitors. Full article
(This article belongs to the Special Issue Management of Atherosclerosis)
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15 pages, 18876 KiB  
Article
Three-Dimensionally Printed Elastic Cardiovascular Phantoms for Carotid Angioplasty Training and Personalized Healthcare
by Krystian Jędrzejczak, Arkadiusz Antonowicz, Beata Butruk-Raszeja, Wojciech Orciuch, Krzysztof Wojtas, Piotr Piasecki, Jerzy Narloch, Marek Wierzbicki and Łukasz Makowski
J. Clin. Med. 2024, 13(17), 5115; https://doi.org/10.3390/jcm13175115 - 28 Aug 2024
Viewed by 899
Abstract
Background/Objective: Atherosclerosis is becoming increasingly common in modern society. Owing to the increasing number of complex angioplasty procedures, there is an increasing need for training in cases where the risk of periprocedural complications is high. Methods: A procedure was developed to obtain three-dimensional [...] Read more.
Background/Objective: Atherosclerosis is becoming increasingly common in modern society. Owing to the increasing number of complex angioplasty procedures, there is an increasing need for training in cases where the risk of periprocedural complications is high. Methods: A procedure was developed to obtain three-dimensional (3D) models and printing of blood vessels. The mechanical and optical properties of the printed materials were also examined. Angioplasty and stent implantation were tested, and the phantom was compared with the clinical data of patients who underwent interventional treatment. Both laser techniques and cone-beam computed tomography of the phantoms were used for comparison. Results: The printed material exhibited mechanical parameters similar to those of blood vessel walls. The refractive index of 1.473 ± 0.002 and high transparency allowed for non-invasive laser examination of the interior of the print. The printed models behaved similarly to human arteries in vivo, allowing training in treatment procedures and considering vessel deformation during the procedure. Models with stents can be analyzed using laser and cone-beam computed tomography to compare stents from different manufacturers. Conclusions: The developed methodology allows for simple and time-efficient production of personalized vessel phantoms. Full article
(This article belongs to the Special Issue Management of Atherosclerosis)
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Review

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16 pages, 1165 KiB  
Review
Role of Lipid-Lowering and Anti-Inflammatory Therapies on Plaque Stabilization
by Krzysztof L. Bryniarski, Wijnand den Dekker, Jacek Legutko, Pawel Gasior, Jeroen Tahon, Roberto Diletti, Jeroen M. Wilschut, Rutger-Jan Nuis, Joost Daemen, Pawel Kleczynski, Nicolas M. Van Mieghem and Ik-Kyung Jang
J. Clin. Med. 2024, 13(11), 3096; https://doi.org/10.3390/jcm13113096 - 25 May 2024
Cited by 4 | Viewed by 1755
Abstract
Atherosclerosis is the predominant underlying etiopathology of coronary artery disease. Changes in plaque phenotype from stable to high risk may spur future major adverse cardiac events (MACE). Different pharmacological therapies have been implemented to mitigate this risk. Over the last two decades, intravascular [...] Read more.
Atherosclerosis is the predominant underlying etiopathology of coronary artery disease. Changes in plaque phenotype from stable to high risk may spur future major adverse cardiac events (MACE). Different pharmacological therapies have been implemented to mitigate this risk. Over the last two decades, intravascular imaging modalities have emerged in clinical studies to clarify how these therapies may affect the composition and burden of coronary plaques. Lipid-lowering agents, such as statins, ezetimibe, and proprotein convertase subtilisin/kexin type 9 inhibitors, were shown not only to reduce low-density lipoprotein levels and MACE but also to directly affect features of coronary plaque vulnerability. Studies have demonstrated that lipid-lowering therapy reduces the percentage of atheroma volume and number of macrophages and increases fibrous cap thickness. Future studies should answer the question of whether pharmacological plaque stabilization may be sufficient to mitigate the risk of MACE for selected groups of patients with atherosclerotic coronary disease. Full article
(This article belongs to the Special Issue Management of Atherosclerosis)
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20 pages, 1030 KiB  
Review
Treatment and Care of Patients with ST-Segment Elevation Myocardial Infarction—What Challenges Remain after Three Decades of Primary Percutaneous Coronary Intervention?
by Vittorio Zuccarelli, Stefano Andreaggi, Jason L. Walsh, Rafail A. Kotronias, Miao Chu, Jonathan Vibhishanan, Adrian P. Banning and Giovanni Luigi De Maria
J. Clin. Med. 2024, 13(10), 2923; https://doi.org/10.3390/jcm13102923 - 15 May 2024
Viewed by 4195
Abstract
Primary percutaneous coronary intervention (pPCI) has revolutionized the prognosis of ST-segment elevation myocardial infarction (STEMI) and is the gold standard treatment. As a result of its success, the number of pPCI centres has expanded worldwide. Despite decades of advancements, clinical outcomes in STEMI [...] Read more.
Primary percutaneous coronary intervention (pPCI) has revolutionized the prognosis of ST-segment elevation myocardial infarction (STEMI) and is the gold standard treatment. As a result of its success, the number of pPCI centres has expanded worldwide. Despite decades of advancements, clinical outcomes in STEMI patients have plateaued. Out-of-hospital cardiac arrest and cardiogenic shock remain a major cause of high in-hospital mortality, whilst the growing burden of heart failure in long-term STEMI survivors presents a growing problem. Many elements aiming to optimize STEMI treatment are still subject to debate or lack sufficient evidence. This review provides an overview of the most contentious current issues in pPCI in STEMI patients, with an emphasis on unresolved questions and persistent challenges. Full article
(This article belongs to the Special Issue Management of Atherosclerosis)
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