Residual risks and evolving atherosclerotic plaques

• Published in: Molecular and cellular biochemistry Vol. 478; no. 12; pp. 2629 - 2643
• Main Authors: Noothi, Sunil K., Ahmed, Mohamed Radwan, Agrawal, Devendra K.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-12-2023; Springer Nature B.V
• Subjects: Angiography; Arteriosclerosis; Atherosclerosis; Biochemistry; Biomedical and Life Sciences; Cancer Research; Cardiology; Carotid Arteries; Carotid artery; Coronary Artery Disease - epidemiology; Developing countries; Epidemiology; Evolution; Health problems; Health risks; Humans; Infrared spectra; Infrared spectroscopy; LDCs; Life Sciences; Lipids; Medical Biochemistry; Morbidity; Near infrared radiation; Plaque, Atherosclerotic; Plaques; Risk Factors; Statins; Stroke; Residual risk; Atherosclerosis; Acute cardiac event; Inflammation; Unstable plaque; Vulnerability; Fibrous cap; Stable Plaque
• ISSN: 0300-8177; 1573-4919
• DOI: 10.1007/s11010-023-04689-0

Atherosclerotic disease of the coronary and carotid arteries is the primary global cause of significant mortality and morbidity. The chronic occlusive diseases have changed the epidemiological landscape of health problems both in developed and the developing countries. Despite the enormous benefit of advanced revascularization techniques, use of statins, and successful attempts of targeting modifiable risk factors, like smoking and exercise in the last four decades, there is still a definite “residual risk” in the population, as evidenced by many prevalent and new cases every year. Here, we highlight the burden of the atherosclerotic diseases and provide substantial clinical evidence of the residual risks in these diseases despite advanced management settings, with emphasis on strokes and cardiovascular risks. We critically discussed the concepts and potential underlying mechanisms of the evolving atherosclerotic plaques in the coronary and carotid arteries. This has changed our understanding of the plaque biology, the progression of unstable vs stable plaques, and the evolution of plaque prior to the occurrence of a major adverse atherothrombotic event. This has been facilitated using intravascular ultrasound, optical coherence tomography, and near-infrared spectroscopy in the clinical settings to achieve surrogate end points. These techniques are now providing exquisite information on plaque size, composition, lipid volume, fibrous cap thickness and other features that were previously not possible with conventional angiography.