Understanding and preventing atherosclerosis: from bench to bedside

For the podcast associated with this article, please visit https://academic.oup.com/eurheartj/pages/Podcasts. Atherosclerosis is the underlying process of chronic and acute coronary syndromes, as well as of certain forms of stroke and peripheral artery disease. Atherosclerotic plaques which are the culprits of the disease process develop over decades, leaving enough room for early preventive measures. As outlined in the special article entitled ‘The Year in Cardiology 2018: prevention’ by Željko Reiner from the University Hospital Center Zagreb, Croatia and colleagues,1 several large-scale studies in cardiovascular prevention have been published in 2018, in particular on novel approaches for dyslipidaemia such as PCSK9 (proprotein convertase subtilisin/kexin type 9) inhibition2–5 and on the impact of SGLT2 (sodium-glucose co-transporter-2) inhibition in diabetics.6,7 Moreover, the 2018 European Guidelines on Arterial Hypertension redefined optimal blood pressure for younger and elderly hypertensives.8 Positive results of trials on the efficacy and safety of advanced renal denervation in hypertension have further expanded the therapeutic spectrum in such patients. Disappointingly, the use of aspirin in primary prevention does not have a favourable risk–benefit ratio,9–12 whereas in patients with atherosclerotic cardiovascular disease at very high risk, the addition of low-dose factor Xa inhibition to aspirin can provide a net clinical benefit.13 New data on inflammation as a treatment target in high-risk patients further expanded secondary prevention in cardiovascular patients.