Advances in atherosclerosis.

Abstract

In the past few years major advances have changed the way we think about atherosclerosis. Treatments for hyperlipidaemia not only regress angiographic stenosis and reduce coronary mortality; in meta-analysis, and in large trials of secondary prevention, they appear to reduce overall mortality. Reduction in events precedes regression of stenosis, partly through stabilization of plaque, and partly by reversal of the endothelial dysfunction caused by oxidized LDL. The study of lipid disorders has been advanced by new understanding of the role of apolipoproteins and lipoprotein (a). Significant advances have also been made in the understanding of effects of angiotensin, fibrinogen, homocysteinaemia, platelets, genetics of atherosclerosis, autoimmunity, flow disturbances and wall stress. Most importantly, because of a revolution in our understanding of the endothelium, we can now begin to make sense of some of the effects of risk factors such as lipids, menopause, flow disturbances, and pressure, to begin to understand atherosclerosis, arterial remodelling and the protective effect of oestrogen in a new light. These changes will profoundly affect the way we practise vascular medicine and neurology, and will give us powerful new ways to help our patients.