title: Atherosclerosis: Recent trials, new targets and future directions.
abstract: Mortality from cardiovascular diseases (CVD) represents the primary cause of death worldwide. Prevention or treatment of atherosclerosis and its clinical sequelae is a central goal in the management of patients with established vascular disease or those at high-risk for vascular events. This paper provides a review of the contemporary pharmacological armamentarium targeting atherosclerosis and also highlights strategies to support future clinical trial design. Powering future trials targeting LDL-cholesterol to its absolute reduction and including patients with a higher LDL-C despite optimal medical therapy (or unable to tolerate statins) will increase the odds of meaningful results. Mendelian randomization studies may identify new causal risk factors for CVD that would help in the selection of the patients most likely to benefit from a specific new compound. Furthermore, imaging techniques integrating a morphological and functional assessment such as IVUS, OCT, PET/CT and PET/MRI may represent in a near future robust "soft" endpoints to support successful translation of early research into meaningful phase III clinical outcome trials.
authors.affiliation: Department of Physiology and Cardiothoracic Surgery, Cardiovascular Research and Development Centre, Faculty of Medicine of the University of Porto, Porto, Portugal; Department of Cardiology, Gaia/Espinho Hospital Centre, Vila Nova de Gaia, Portugal. Electronic address: ricardoladeiraslopes@gmail.com.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Ladeiras-Lopes
authors.affiliation: Department of Cardiology, Oslo University Hospital Ullevål and Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
authors.forename: Stefan
authors.initials: S
authors.lastname: Agewall
authors.affiliation: Cardiology Division, Massachusetts General Hospital, Boston, MA, USA; Cardiology Division, Harvard Medical School, Boston, MA, USA.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Tawakol
authors.affiliation: INSERM UMR1011, Univ. Lille 2, Institut Pasteur de Lille, EGID, Lille, France.
authors.forename: Bart
authors.initials: B
authors.lastname: Staels
authors.affiliation: Metabolic and Atherosclerosis Research Centre, Cincinatti, OH, USA.
authors.forename: Evan
authors.initials: E
authors.lastname: Stein
authors.affiliation: Duke Clinical Research Institute and the Division of Cardiology, Duke University Hospital, Durham, NC, USA.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Mentz
authors.affiliation: Department of Physiology and Cardiothoracic Surgery, Cardiovascular Research and Development Centre, Faculty of Medicine of the University of Porto, Porto, Portugal.
authors.forename: Adelino
authors.initials: A
authors.lastname: Leite-Moreira
authors.affiliation: INSERM, Centre d'Investigation Clinique-9501, Université de Lorraine, Nancy, France.
authors.forename: Faiez
authors.initials: F
authors.lastname: Zannad
authors.affiliation: Department of Internal Medicine II - Cardiology, University of Ulm Medical Center, Ulm, Germany; Deutsches Herzzentrum München, Technische Universität München, Munich Germany; DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany. Electronic address: koenig@dhm.mhn.de.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Koenig
mesh_terms: D050197:Atherosclerosis / Q000188:drug therapy*; D002986:Clinical Trials as Topic; D006801:Humans; D058990:Molecular Targeted Therapy
keywords: Atherosclerosis; Clinical research; Pharmacology