Current and emerging drugs for the treatment of atherosclerosis: the evidence to date

ABSTRACT

Introduction

Atherosclerosis can be considered a chronic inflammatory process that stands out as a dominant cause of cardiovascular disease (CVD). Since blood lipids are the leading risk factor for atherosclerosis development, lowering low-density lipoprotein cholesterol (LDL-C) and other apolipoprotein B-containing lipoproteins reduces the risk of future cardiovascular events. However, there has been significant progress in developing lipid-lowering drugs for aggressive management of dyslipidemia, the rates of CVD events remain unacceptably high, so there is great need to identify novel therapeutic pathways targeting the atherosclerosis process.

Areas covered

We discussed the current guidelines on CVD prevention, the role of novel lipid-lowering drugs, as well as emerging drugs for atherosclerosis, emphasizing the current data on compounds targeting inflammatory and oxidant pathways.

Expert Opinion

Although novel lipid-lowering drugs all showed their therapeutic efficacy in LDL-C lowering, data regarding their impact on cardiovascular outcomes is still inconclusive. On the other hand, some of the agents targeting inflammatory pathways, especially colchicine, showed promising results in terms of reducing CVD events. In contrast, those pointed at oxidant pathways failed to do so. Finally, exploring ways of targeting new therapeutic venues, such as adaptive immunity and clonal hematopoiesis, is a goal in the future.

KEYWORDS:

• Atherosclerosis
• cardiovascular disease
• inflammation
• oxidative stress
• prevention

Article highlights

• Atherosclerosis represents a chronic inflammatory process that is a dominant cause of cardiovascular disease.

• The lowering of low-density lipoprotein cholesterol and other apolipoprotein B-containing lipoproteins reduces the risk of future cardiovascular events.

• While there has been great progress in managing dyslipidemia, the rates of cardiovascular disease events remain unacceptably high, so novel therapeutic pathways targeting the atherosclerosis process should be identified.

• Clinical data suggest that some of the agents targeting inflammatory pathways, especially colchicine, show promising results in terms of reducing cardiovascular events.

• Exploring the ways of targeting other potential therapeutic venues, such as adaptive immunity and clonal hematopoiesis, is a goal in the future.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.