Is it possible to treat coronary atherosclerosis before it leads to a heart attack? The role of cardiac diagnostics

By Cristiano Antonino On Mar 7, 2023

Coronary atherosclerosis is a disease that affects arterial vessels, leading to the formation of plaques, with a lipid content, in the arteries that carry blood to the heart

This type of disease can have serious consequences on the health of the affected individual, so prevention is essential.

What is coronary atherosclerosis

Coronary atherosclerosis is a disease affecting the walls of the arteries of the coronary circulation.

This disease is characterised by the formation of lipid accumulations (plaques) that cause narrowing and occlusions in the arteries that carry blood and oxygen to the heart.

This disease affects our arterial vessels resulting in the formation of plaques composed mainly of derivatives of cholesterol, the fat present in the blood.

It is a disease that progresses over the years: the plaque becomes more voluminous and narrows the inner portion of the blood vessel.

The lipid formation, obstructing the natural blood path, prevents adequate cardiac perfusion.

The consequences

The disease can remain silent or stable throughout the patient’s life, leading to no symptoms or acute events, but in most cases it can lead to more severe disease.

In most patients there is what is known as exertional angina, an exercise-induced myocardial ischaemia, characterised by chest pain and shortness of breath.

In more unfortunate individuals, however, there may be acute occlusion of the vessel caused by thrombosis.

An instantaneous occlusion of the vessel that overlaps with severe stenosis of 70/80/90%.

An ischaemia so severe that, if not revascularised early, it can lead to necrosis of part of the heart muscle, the actual myocardial infarction.

What is the incidence of coronary atherosclerosis

Coronary atherosclerosis is an epidemiologically extremely relevant problem.

Cardiovascular diseases rank first in terms of mortality: coronary atherosclerosis is numerically relevant and leads the causes of mortality from cardiovascular diseases in Italy and in all western countries.

We are therefore talking about a serious pathology with possible serious consequences, but which today can be treated with early resolution, limiting myocardial damage.

The causes and symptoms of coronary atherosclerosis

The main risk factors for coronary atherosclerosis are:

hypercholesterolaemia;
arterial hypertension;
diabetes mellitus, both type I and type II;
family history of coronary artery disease, i.e. first-degree relatives who have had a coronary event at a young age (under 65 in females, under 55 in males);
cigarette smoking.

All these factors combine to generate and accelerate the development and progression of coronary artery disease.

Some risk factors, such as diabetes, are particularly insidious and dangerous.

On the one hand, they contribute to the lively and widespread generation and progression of atherosclerosis, and on the other hand, they cause a blurring of symptoms.

Symptomatically, coronary artery disease is identified by:

oppressive chest pain;
shortness of breath.

There is the whole cohort of asymptomatic subjects and subjects, a confounding factor, with atypical symptoms.

For example, coronary artery disease affecting the right coronary artery may be confused with a gastrointestinal problem.

How to slow down or treat Coronary Atherosclerosis

Medical guidelines say that in subjects with documented coronary atherosclerosis it is necessary to reduce LDL-cholesterol, the bad one, to values below 55 mg/dl (values always considered correct around 130 mg/dl).

The latest studies have shown that there is no unambiguous value for optimal cholesterol for every patient, the blood lipid concentration must have a reference level depending on cardiovascular risk.

Achieving the appropriate target reduces mortality from heart attacks by approximately 40/50%.

Nowadays, there are many drugs that help in the hypolipidemic process (reduction of blood lipids):

the statin, which reduces hepatic synthesis;
ezetimibe, which reduces intestinal absorption of cholesterol.

When this approach is not enough, and according to data from the Society of Cardiology it is not enough in 50/60% of cases, we have new weapons:

PCSK9 inhibitors, drugs administered subcutaneously every 2/3 weeks;
a brand new drug that is administered subcutaneously twice a year also dubbed the ‘atherosclerosis vaccine’.

Preventing coronary atherosclerosis: the role of cardiac diagnostics

Certainly, the first prevention tool is clinical evaluation.

Assessment that can be the responsibility of the general practitioner and, if suspected.

For prevention, it is essential to pay particular attention to certain elements

the general risk profile
the intervention on modifiable risk factors;
the patient’s age;
the sex of the patient.

Nowadays we have the possibility of doing many diagnostic tests that can be a great starting point for prevention.

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Fundamental tools are:

Exercise echocardiography, which is extremely useful in the female sex and improves both sensitivity and specificity in detecting myocardial ischaemia;
Stress MRI, a third-level test limited to patients with a strong clinical suspicion;
CT scans of the coronary arteries.
Cardiac imaging (cardiac imaging) is fundamental in explaining the clinical assessment of pathology to the patient. It is the concrete means by which the patient visually identifies coronary artery disease.
Cardiac diagnostics is pure primary prevention and fits very well with the concept of precision medicine.

Nothing is more precise than going to assess the pathology in that specific subject.

In fact, imaging makes it possible to identify exactly