Bridging the gap for lipid lowering therapy: plaque regression, coronary computed tomographic angiography, and imaging-guided personalized medicine. (3rd July 2017)

• Record Type: Journal Article
• Authors: Kwan, Alan C; Aronis, Konstantinos N; Sandfort, Veit; Blumenthal, Roger S; Bluemke, David A
• Is Part Of: Expert review of cardiovascular therapy. Volume 15:Number 7(2017)
• Page Start: 547
• Page End: 558
• Publication Date: 2017-07-03
• Subjects: Cardiac computed tomography -- coronary atherosclerosis -- coronary computed tomographic angiography -- lipid-lowering therapy -- PCSK-9 -- personalized medicine -- plaque regression -- statin; Cardiovascular agents -- Research -- Periodicals; 616.12061
• DOI: 10.1080/14779072.2017.1348228
• Languages: English
• ISSNs: 1477-9072

Abstract

ABSTRACT: 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.