Review: Changing views on atherosclerosis

Atherosclerosis—hardening of the arteries—is now involved in the majority of deaths worldwide, and advances in our understanding of the biology of the disease are changing traditional views and opening up new avenues for treatment.

The picture of who may be at risk for a heart attack has evolved considerably in recent decades. At one time, a heart attack might have conjured up the image of a middle-aged white man with high cholesterol and high blood pressure who smoked cigarettes. Today, traditional concepts of what contributes to risk have changed. These updated views include new thinking around:

• Global disease burden: Atherosclerotic cardiovascular disease is now the leading cause of death worldwide.
• Clinical profile: Women, younger individuals, and people of diverse backgrounds bear an increasing burden of atherosclerotic cardiovascular disease.
• Role of "good cholesterol": The protective role of HDL cholesterol (so-called "good cholesterol") has been called into question and triglycerides have emerged as a promising target for reducing heart disease risk.
• Inflammation drives atherosclerosis: New data suggests that inflammation may be a critical link between traditional risk factors such as abnormal lipids, smoking, and diabetes and complications of atherosclerosis including heart attack and stroke.

"Advances in our understanding of the biology of atherosclerosis have opened avenues to therapeutic interventions that promise to improve the prevention and treatment of now-ubiquitous atherosclerotic diseases," writes Libby. "From a therapeutic perspective, we have reason for optimism in addressing the growing burden of atherosclerotic risk."