Lifelong Atherosclerosis: Stages of Diagnosis and Treatment
https://doi.org/10.51922/2616-633X.2026.10.1.2702
Abstract
Cardiovascular diseases remain the leading cause of death worldwide and account for the majority of healthcare costs. The presence of systemic atherosclerosis is primarily assessed at the clinical stage, most often ischemic, with the development of myocardial infarction, ischemic stroke, and acute arterial insufficiency. Practicing physicians require a step-by-step algorithm for the diagnosis and treatment of systemic atherosclerosis, taking into account the diversity of dyslipidemia with increased levels of low-density cholesterol, triglycerides, and atherogenic lipoproteins. This article proposes an approach that ranges from identifying risk factors for systemic atherosclerosis, determining cardiovascular risk using the SCORE scale, and assessing dyslipoproteinemia, including familial hypercholesterolemia, to the step-by-step determination of vascular stiffness, the presence of atherosclerotic plaque, the degree of vascular stenosis, and instability, as well as the selection of drug therapy and assessment of its efficacy and safety, reduction of overall cardiovascular risk, and increased survival based on data from international randomized trials. New approaches to diagnosing atherosclerotic plaque instability in the internal carotid artery system are presented, which may become an important milestone in stroke prevention. Combination lipid-lowering therapy is a modern approach to increasing survival in cardiovascular patients.
References
1. Ezhov M.V., Kukharchuk V.V., Sergienko I.V., Alieva A.S., Antsiferov, M.B., Ansheles A.A., Arabidze G.G., Aronov D.M., Arutyunov G.P., Akhmedzhanov, N.M., Balakhonova T.V., Barbarash O.L., Boytsov S.A., Bubnova M.G., Voevoda M.I., Galstyan G.R., Galyavich A.S., Gornyakova N.B., Gurevich V.S., Dedov I.I., Drapkina O.M., Duplyakov D.V., Eregin S.Ya., Ershova A.I., Irtyuga O.B., Karpov R.S., Karpov Yu.A., Kachkovsky M.A., Kobalava Zh.D., Koziolova N.A., Konovalov G.A., Konstantinov V.O., Kosmacheva E.D., Kotovskaya Yu.V., Martynov, A.I., Meshkov A.N., Nebieridze D.V., Nedogoda S.V., Obrezan A.G., Oleinikov, V.E., Pokrovsky S.N., Ragino Yu.I., Rotar O.P., Skibitsky V.V., Smolenskaya, O.G., Sokolov A.A., Sumarokov A.B., Tkacheva O.N., Filippov A.E., Halimov, Yu. Sh., Chazova I.E., Shaposhnik I.I., Shestakova M.V., Yakushin S.S., Shlyakhto E.V. Disorders of lipid metabolism. Clinical Guidelines 2023. Journal of Cardiology. 2023;28(5):5471. doi:10.15829/1560-4071-2023-5471. EDN YVZOWJ (In Russian).
2. Kukharchuk V.V., Ezhov M.V., Sergienko I .V. i dr. Diagnostika i korrektsiya narushenii li pidnogo obmena s tsel’yu profilaktiki i lecheniya ateroskleroza. Rossiiskie rekomendatsii, VII peresmotr. Ateroskleroz i dislipidemii. 2020;11;1(38) (In Russian).
3. Ginsberg HN, Packard CJ, Chapman MJ, et al. Triglyceride-rich lipoproteins and their remnants: metabolic insights, role in atherosclerotic cardiovascular disease, and emerging therapeutic strategies-a consensus statement from the European Atherosclerosis Society. Eur Heart J. 2021;42(47):4791-806. doi:10.1093/eurheartj/ehab551
4. Siasos, G.; Sara, J. D.; Zaromitidou, M.; Park, K. H.; Coskun, A. A.; Lerman, L. O.; Oikonomou, E.; Maynard, K. K.; Fotiadis, D.; Stefanou, K.; Papafaklis, M.; Michalis, L.; Feldman, K.; Lerman, A.; Stone, P. H. Local low shear stress and endothelial dysfunction in patients with non-obstructive coronary atherosclerosis.J. Am. Coll. Cardiol., 2018, 71 (19), 2092-2102. http://dx.doi.org/10.1016/j.jacc.2018.02.073 PMID: 29747829
5. Ibanez B., Fernández-Ortiz A., Fernández-Friera L. Progression of Early Subclinical Atherosclerosis (PESA) study: JACC focus seminar 7/8. J Am Coll Cardiol. 2021;78(2):156–179. doi: 10.1016/j.jacc.2021.05.011
6. Ershova A.I., Balakhonova T.V., Meshkov A.N., Kutsenko V.A., Yarovaya E.B., Shal’nova S.A., Lishchenko N.E., Novikova A.S., Aleksandrova E.L., Shutemova E.A., Belova O.A., Rachkova S.A., Boitsov S.A., Drapkina O.M. Rasprostranennost’ ateroskleroza sonnykh i bedrennykh arterii sredi naseleniya Ivanovskoi oblasti: issledovanie ATEROGEN-Ivanovo. Kardiovaskulyarnaya terapiya i profilaktika. 2021;20(5):2994. https://doi.org/10.15829/1728-8800-2021-2994 (In Russian).
7. Casolo G., Gabrielli D., Colivicchi F. ANMCO POSITION PAPER: prognostic and therapeutic relevance of non-obstructive coronary atherosclerosis. Eur Heart J Suppl. 2021;23(Suppl C):C164–C175. doi: 10.1093/eurheartj/suab072.
8. Henein M.Y., Vancheri S., Bajraktari G. Coronary atherosclerosis imaging. Diagnostics. 2020;10(2):65. doi: 10.3390/diagnostics10020065.
9. Cai J.M. et al. Classification of human carotid atherosclerotic lesions with in vivo multicontrast magnetic resonance imaging // Circulation. Circulation, 2002. Vol. 106, № 11. P. 1368–1373.
10. Dong S. et al. Diagnostic Performance of Atherosclerotic Carotid Plaque Neovascularization with Contrast-Enhanced Ultrasound: A Meta-Analysis // Comput Math Methods Med. Comput Math Methods Med, 2022. Vol. 2022.
11. Balakhonova T.V., Timina I.E., Chechetkin A.O., Shul’giga L.E. Ul’trazvukovye aspekty primeneniya Carotid Plaque-RADS – sistemy stratifikatsii ostrykh ishemicheskikh tserebral’nykh sobytii. Angiologiya i sosudistaya khirurgiya. Zhurnal imeni akademika A.V.Pokrovskogo. 2025;31(4): 22-32. DOI:https://doi.org/10/33029/1027-6661-2025-31-4-22-32. (In Russian).
12. Ezhov M.V., Kukharchuk V.V., Balakhonova T.V., Gurevich V.S., Sergienko I.V., Sokolov A.A., Semenkin A.A., Shaposhnik I.I., Akhmedzhanov N.M., Barbarash O.L., Bubnova M.G., Voevoda M.I., Galyavich A.S., Eregin S.YA., Konovalov G.A., Korneva V.A., Pokrovskii S.N., Raskurazhev A.A., Skibitskii V.V., Tanashyan M.M., Filippov A.E., Chazova I.E., Chubykina U.V., Yakushin S.S. Klinicheskie rekomendatsii Evraziiskoi assotsiatsii kardiologov (EAK)/ Natsional’nogo obshchestva po izucheniyu ateroskleroza (NOA) po diagnostike i korrektsii narushenii lipidnogo obmena s tsel’yu profilaktiki i lecheniya ateroskleroza (2025). Evraziiskii kardiologicheskii zhurnal. 2025;(2):6-34. https://doi.org/10.38109/2225-1685-2025-2-6-34 (In Russian).
13. Metelskaya V.A., Shalnova S.A., Deev A.D. Analysis of the prevalence of indicators characterizing the atherogenicity of the spectrum of lipoproteins among residents of the Russian Federation (according to the ESSE-RF study). Preventive medicine. 2016;19(1):15-23. (In Russian).
14. Castelli W.P. Epidemiology of triglycerides: A view from Framingham. Am J Cardiol. 1992;70(19):3H-9H. doi:10.1016/0002-9149(92)91083-g
15. Аggiula A.W., Christakis G., Farrand M., et al. The multiple risk factor intervention trial (MRFIT): IV. Intervention on blood lipids. Preventive Medicine. 1981;10(4):443-75. doi:10.1016/0091-7435(81)90060-8.
16. Nordestgaard B.G., Chapman M.J., Humphries S.E., et al. Familial hyper-cholesterolaemia is underdiagnosed and undertreated in the general population: guidance for clinicians to prevent coronary heart disease: consensus statement of the European Atherosclerosis Society. Eur Heart J. 2013;34(45):3478-90a. doi:10.1093/eurheartj/eht273.
17. Taylor F., Huffman M.D., Macedo A.F., et al. Statins for the primary prevention of cardiovascular disease. Cochrane Database of Systematic Reviews. 2013; 2013(1):CD004816. doi:10.1002/14651858.cd004816.pub5.
18. Boekholdt S.M., Hovingh G.K., Mora S., et al. Very Low Levels of Atherogenic Lipoproteins and the Risk for Cardiovascular Events. J Am Coll Cardiol. 2014;64(5):485-94. doi:10.1016/j.jacc.2014.02.615.
19. Group SC. Study of Heart and Renal Protection (SHARP): Randomized trial to assess the effects of lowering low-density lipoprotein cholesterol among 9,438 patients with chronic kidney disease. Am Heart J . 2010;160(5):785-94.e710. doi:10.1016/j.ahj.2010.08.012.
20. Abifadel M., Varret M., Rabès J-P., et al. Mutations in PCSK9 cause autosomal dominant hypercholesterolemia. Nat Genet. 2003;34(2):154-6. doi:10.1038/ng1161.
21. Norata G.D., Tibolla G., Catapano A.L. Targeting PCSK9 for Hypercholesterolemia. Annual Review of Pharmacology and Toxicology. 2014;54(1):273-93. doi:10.1146/annurev-pharmtox-011613-140025
22. Ray K.K., Wright R.S., Kallend D., et al. Two phase 3 trials of Inclisiran in patients with eleva-ted LDL cholesterol. N Engl J Med. 2020;382(16):1507-19. doi:10.1056/NEJMoa1912387.
Review
For citations:
Salivonchik D.P. Lifelong Atherosclerosis: Stages of Diagnosis and Treatment. Emergency Cardiology and Cardiovascular Risks journal. 2026;10(1):2702-2715. (In Russ.) https://doi.org/10.51922/2616-633X.2026.10.1.2702
Views:
44
JATS XML
Email this article 