Advances in the Understanding of Plaque Composition and Treatment Options

Atherosclerosis research has classically followed 2 intertwining lines of investigation concerning atherosclerosis as a local process (the high-risk plaque) and as a systemic disease (the high-risk patient). Over time, the weight of attention has swung, like a pendulum, between these 2 related foci. With optimal medical therapy and attention to risk factors firmly established as fundamental aspects of management, in the past year, we have nevertheless perceived a shift in the pendulum toward renewed focus on the local plaque. We contend that this shift results from a convergence of major advances in understanding the biology of plaque progression, novel sophisticated invasive and noninvasive imaging modalities for the in vivo characterization of plaque composition and inflammation, and emerging data and technologies that have renewed interest in locally targeted interventions. Here, we review the dynamic and exciting progress that has occurred over the last 12 months in this arena, while acknowledging future work that remains to be done to refine and validate new imaging modalities and therapies. (C) 2014 by the American College of Cardiology Foundation