Coronary Atherosclerosis Burden and Progression to Guide Clinical Decision Making: A Report from the American College of Cardiology Innovations in Prevention Working Group. The American journal of medicine Freeman, A. M., Raman, S. V., Aggarwal, M., Maron, D. J., Bhatt, D. L., Parwani, P., Osborne, J., Earls, J. P., Min, J. K., Shapiro, M. D. 2022


Although atherosclerosis represents the primary driver of coronary artery disease, evaluation and treatment approaches have historically relied upon indirect markers of atherosclerosis that include surrogates (cholesterol), signs (angina) and sequelae (ischemia) of atherosclerosis. Direct quantification and characterization of atherosclerosis may encourage a precision heart care paradigm that improves diagnosis, risk stratification, therapeutic decision making and longitudinal disease tracking in a personalized fashion.The American College of Cardiology Innovations in Prevention Working Group introduces the Atherosclerosis Treatment Algorithms that personalize medical interventions based upon atherosclerosis findings from coronary computed tomography angiography and cardiovascular risk factors. Through integration of coronary computed tomography angiography -based atherosclerosis evaluation, clinical practice guidelines and contemporary randomized controlled trial evidence, the Atherosclerosis Treatment Algorithms leverage patient-specific atherosclerosis burden and progression as primary targets for therapeutic intervention. After defining stages of atherosclerosis severity by coronary computed tomography angiography, Atherosclerosis Treatment Algorithms are described for worsening stages of atherosclerosis for patients with lipid disorders, diabetes, hypertension, obesity, and tobacco use. The Working Group anticipates a rapid pace of research in the field, and the manuscript concludes by providing perspectives on future needs that may improve efforts to optimize precision prevention of coronary artery disease. Importantly, the Atherosclerosis Treatment Algorithms are not endorsed by the American College of Cardiology nor should the Atherosclerosis Treatment Algorithms be interpreted as a statement of American College of Cardiology policy.We describe a precision heart care approach that emphasizes atherosclerosis as the primary disease target for evaluation and treatment. To our knowledge, this effort represents the first to propose coronary atherosclerosis burden and progression to personalize therapy selection and therapy changes, respectively.

View details for DOI 10.1016/j.amjmed.2022.10.021

View details for PubMedID 36509122