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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 causes.

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.

Imaging atherosclerosis

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.”

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Reviewed on August 08, 2008

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