心血管疾患と診断

Are We Stagnant at Managing Atherosclerosis? A Review on Emergent Therapies in Treating Coronary Artery Disease (CAD)

Abstract

Riddhi Machchhar*, Tasfia Tasnim and Carl Hock

Presently, Coronary Artery Disease (CAD) is medically managed to reduce cardiovascular morbidity and mortality, improve ischemic burden and maintain quality of life. Development of underlying atherosclerosis may be prevented via primordial prevention with risk management but once the inflammatory process of plaque formation initiates, there is a lack of therapeutic intervention in reversing this cascade. Conventional therapies include long-term pharmacologic management with aspirin and antiplatelet agents in reducing the risk of thrombosis. Furthermore, surgical management with coronary artery bypass graft and coronary artery stenting have shown efficacy in dec reasing mortality, yet the risk of restenosis is relatively high. This paper explores emerging therapies in surgical intervention, the use of nanotechnology, and pharmacological advancements in managing and somewhat reversing atherosclerosis in CAD. Innovation to coronary stenting is brought by the integration of nanocoated metals and biodegradable-polymer drug-eluting stents that have shown optimal efficacy when compared to traditional stent architecture. Similarly, nanotechnology is at the forefront of CAD research with promising reversal of atherosclerosis. It does so by mimicking the intrinsic properties of HDL and targeting lesional macrophages involved in continuous inflammation in a vulnerable plaque. Much more, exploring pharmacological advancement reveals the current development of drug encapsulated cargo-switching nanoparticles and the harnessing of existing anti-inflammatory agents in managing atherosclerosis. Whether these advancements can be practically implemented in managing atherosclerosis or stay as theoretical proposals in literature is up for discussion in the field of cardiology.