TY - JOUR
T1 - Bridging the gap for lipid lowering therapy
T2 - plaque regression, coronary computed tomographic angiography, and imaging-guided personalized medicine
AU - Kwan, Alan C.
AU - Aronis, Konstantinos N.
AU - Sandfort, Veit
AU - Blumenthal, Roger S.
AU - Bluemke, David A.
N1 - Funding Information:
This paper was funded by the National Institutes of Health, grant ID: EB000072.
Publisher Copyright:
© 2017 Informa UK Limited, trading as Taylor & Francis Group.
PY - 2017/7/3
Y1 - 2017/7/3
N2 - Introduction: Lipid-lowering therapy effectively decreases cardiovascular risk on a population level, but it remains difficult to identify an individual patient’s personal risk reduction while following guideline directed medical therapy, leading to overtreatment in some patients and cardiovascular events in others. Recent improvements in cardiac CT technology provide the ability to directly assess an individual’s atherosclerotic disease burden, which has the potential to personalize risk assessment for lipid-lowering therapy. Areas covered: We review the current unmet need in identifying patients at elevated residual risk despite guideline directed medical therapy, the evidence behind plaque regression as a potential marker of therapeutic response, and highlight state-of-the-art advances in coronary computed tomographic angiography (CCTA) for measurement of quantitative and qualitative changes in coronary atherosclerosis over time. Literature search was performed using PubMed and Google Scholar for literature relevant to statin therapy and residual risk, coronary plaque regression measurement, and CCTA assessment of quantitative and qualitative change in coronary atherosclerosis. Expert commentary: We discuss the potential ability of CCTA to guide lipid-lowering therapy as a bridge between population and personalized medicine in the future, as well as the potential barriers to its use.
AB - Introduction: Lipid-lowering therapy effectively decreases cardiovascular risk on a population level, but it remains difficult to identify an individual patient’s personal risk reduction while following guideline directed medical therapy, leading to overtreatment in some patients and cardiovascular events in others. Recent improvements in cardiac CT technology provide the ability to directly assess an individual’s atherosclerotic disease burden, which has the potential to personalize risk assessment for lipid-lowering therapy. Areas covered: We review the current unmet need in identifying patients at elevated residual risk despite guideline directed medical therapy, the evidence behind plaque regression as a potential marker of therapeutic response, and highlight state-of-the-art advances in coronary computed tomographic angiography (CCTA) for measurement of quantitative and qualitative changes in coronary atherosclerosis over time. Literature search was performed using PubMed and Google Scholar for literature relevant to statin therapy and residual risk, coronary plaque regression measurement, and CCTA assessment of quantitative and qualitative change in coronary atherosclerosis. Expert commentary: We discuss the potential ability of CCTA to guide lipid-lowering therapy as a bridge between population and personalized medicine in the future, as well as the potential barriers to its use.
KW - Cardiac computed tomography
KW - PCSK-9
KW - coronary atherosclerosis
KW - coronary computed tomographic angiography
KW - lipid-lowering therapy
KW - personalized medicine
KW - plaque regression
KW - statin
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U2 - 10.1080/14779072.2017.1348228
DO - 10.1080/14779072.2017.1348228
M3 - Review article
C2 - 28657444
AN - SCOPUS:85022187980
SN - 1477-9072
VL - 15
SP - 547
EP - 558
JO - Expert review of cardiovascular therapy
JF - Expert review of cardiovascular therapy
IS - 7
ER -