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Subclinical Atherosclerosis to Guide Treatment in Dyslipidemia and Diabetes Mellitus

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Abstract

Purpose of Review

Dyslipidemia and type 2 diabetes mellitus are two common conditions that are associated with an increased risk of atherosclerotic cardiovascular disease (ASCVD). In this review, we aimed to provide an in-depth and contemporary review of non-invasive approaches to assess subclinical atherosclerotic burden, predict cardiovascular risk, and guide appropriate treatment strategies. We focused this paper on two main imaging modalities: coronary artery calcium (CAC) score and computed tomography coronary angiography.

Recent Findings

Recent longitudinal studies have provided stronger evidence on the relationship between increased CAC, thoracic aorta calcification, and risk of cardiovascular events among those with primary hypercholesterolemia, highlighting the beneficial role of statin therapy. Interestingly, resilient profiles of individuals not exhibiting atherosclerosis despite dyslipidemia have been described. Non-conventional markers of dyslipidemia have also been associated with increased subclinical atherosclerosis presence and burden, highlighting the contribution of apolipoprotein B-100 (apoB)-rich lipoprotein particles, such as remnant cholesterol and lipoprotein(a), to the residual risk of individuals on-target for low-density lipoprotein cholesterol (LDL-C) goals. Regarding type 2 diabetes mellitus, variability in atherosclerotic burden has also been found, and CAC testing has shown significant predictive value in stratifying cardiovascular risk.

Summary

Non-invasive assessment of subclinical atherosclerosis can help reveal the continuum of ASCVD risk in those with dyslipidemia and diabetes mellitus and can inform personalized strategies for cardiovascular disease prevention in the primary prevention setting.

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Data Availability

No datasets were generated or analysed during the current study.

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Authors and Affiliations

  1. Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA

    Reed Mszar

  2. School of Medicine, New York Medical College, Valhalla, NY, USA

    Miriam E. Katz

  3. Virginia Commonwealth University Health Pauley Heart Center, Richmond, VA, USA

    Gowtham R. Grandhi

  4. Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Albert D. Osei

  5. Department of Nutrition, Lipidology and Cardiovascular Prevention Unit, APHP, INSERM UMR1166, Hôpital Pitié-Salpètriêre, Sorbonne Université, Paris, France

    Antonio Gallo

  6. Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Michael J. Blaha

  7. Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA

    Michael J. Blaha

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  1. Reed Mszar
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  2. Miriam E. Katz
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RM, MEK, GRG, ADO, AG, and MJB wrote the main manuscript text and prepared the figures. All authors reviewed the manuscript.

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Correspondence to Michael J. Blaha.

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Dr. Gallo has received grants and personal fees from Amgen, Sanofi and Regeneron, Mylan Viatris, MSD, Akcea Therapeutics, Amryt, Novartis, Servier, Eli Lilly, Ultragenyx. Dr. Blaha has received grants from NIH, FDA, AHA, Amgen, Novo Nordisk, Bayer and is on the Advisory Boards of Novartis, Novo Nordisk, Bayer, Roche, Merck, Astra Zeneca, Boehringer Inhgelheim, Agepha, Vectura.

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Mszar, R., Katz, M.E., Grandhi, G.R. et al. Subclinical Atherosclerosis to Guide Treatment in Dyslipidemia and Diabetes Mellitus. Curr Atheroscler Rep (2024). https://doi.org/10.1007/s11883-024-01202-w

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