Breakthroughs in Atherosclerosis Treatment
New research may lead to new drugs for heart disease.
Anti-inflammatories for the heart continued...
Besides HDL therapies, “the second area of interest is clearly the
inflammation story,” Nicholls says. In general, researchers agree inflammation
plays a key role in plaque formation and subsequent plaque rupture, which can
lead to a heart attack, Nicholls says. Some drugs, such as statins, lower LDL
cholesterol and may also have anti-inflammatory effects, he adds. However,
researchers hope to develop entirely new types of drugs that specifically
prevent or reduce inflammation in artery walls, perhaps by attacking root
Although no anti-inflammatory therapy to date has reached an advanced stage
in clinical trials, “it’s clearly a very important area because it would seem
to be an obvious complement to the therapies we already have, if we can show
they work,” he says.
Advances in computed tomography, positron emission tomography, and magnetic
resonance imaging are allowing researchers to study atherosclerotic plaque in
greater detail, sometimes down to the cellular level. The various imaging
techniques can examine artery wall thickness, amount of blockage, and
composition and metabolic activity of plaque.
Right now, the imaging advances are in clinical trials, and none has
progressed to the point of being able to predict a person’s coronary risk,
according to Zahi A. Fayad, PhD, a Mount Sinai School of Medicine researcher in
New York City who has investigated imaging of plaques. Instead, scientists are
using the new techniques to help assess effectiveness of therapies. For
example, through imaging, scientists can check whether a certain treatment is
causing plaque to regress.
Research on atherosclerosis genetics
Scientists who attempt to unravel the complex genetics behind
atherosclerosis face a tough task. “We’re dealing with a very complicated
disease,” Nicholls says. “There’s no one magic gene or one major cause.”
Nevertheless, genetic research holds potential for new therapies as well as
treatment tailored to a person’s specific genetic profile. For instance, some
genes have been linked to heart disease, which opens the door to new
therapeutic targets. “If we identify genes that are associated with a greater
risk, then we work backwards,” Nicholls says. Scientists can search for
proteins that the genes regulate because these proteins might contribute to
development of heart disease. “They become a target for a new therapy,”
Nicholls says. “That is a very exciting area.”
Further, genetic discoveries may help doctors in the future identify the
best therapy for a particular patient. “At the moment, we have a very broad
approach. We have a lot of drugs that seem to be effective in reducing
cardiovascular risk, but we’re not very good at working out which patients are
likely to benefit more from one drug as compared to another,” Nicholls says.
“It may be that you could genetically profile a patient,” he adds, which could
help a person take a smaller number of more effective drugs, rather than
“asking patients to take more and more drugs.”