IDEAS home Printed from https://ideas.repec.org/a/nat/nature/v592y2021i7855d10.1038_s41586-021-03392-8.html
   My bibliography  Save this article

The changing landscape of atherosclerosis

Author

Listed:
  • Peter Libby

    (Brigham and Women’s Hospital
    Harvard Medical School)

Abstract

Emerging evidence has spurred a considerable evolution of concepts relating to atherosclerosis, and has called into question many previous notions. Here I review this evidence, and discuss its implications for understanding of atherosclerosis. The risk of developing atherosclerosis is no longer concentrated in Western countries, and it is instead involved in the majority of deaths worldwide. Atherosclerosis now affects younger people, and more women and individuals from a diverse range of ethnic backgrounds, than was formerly the case. The risk factor profile has shifted as levels of low-density lipoprotein (LDL) cholesterol, blood pressure and smoking have decreased. Recent research has challenged the protective effects of high-density lipoprotein, and now focuses on triglyceride-rich lipoproteins in addition to low-density lipoprotein as causal in atherosclerosis. Non-traditional drivers of atherosclerosis—such as disturbed sleep, physical inactivity, the microbiome, air pollution and environmental stress—have also gained attention. Inflammatory pathways and leukocytes link traditional and emerging risk factors alike to the altered behaviour of arterial wall cells. Probing the pathogenesis of atherosclerosis has highlighted the role of the bone marrow: somatic mutations in stem cells can cause clonal haematopoiesis, which represents a previously unrecognized but common and potent age-related contributor to the risk of developing cardiovascular disease. Characterizations of the mechanisms that underpin thrombotic complications of atherosclerosis have evolved beyond the ‘vulnerable plaque’ concept. These advances in our understanding of the biology of atherosclerosis have opened avenues to therapeutic interventions that promise to improve the prevention and treatment of now-ubiquitous atherosclerotic diseases.

Suggested Citation

  • Peter Libby, 2021. "The changing landscape of atherosclerosis," Nature, Nature, vol. 592(7855), pages 524-533, April.
  • Handle: RePEc:nat:nature:v:592:y:2021:i:7855:d:10.1038_s41586-021-03392-8
    DOI: 10.1038/s41586-021-03392-8
    as

    Download full text from publisher

    File URL: https://www.nature.com/articles/s41586-021-03392-8
    File Function: Abstract
    Download Restriction: Access to the full text of the articles in this series is restricted.

    File URL: https://libkey.io/10.1038/s41586-021-03392-8?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Xiaoxue Fu & Xiaojuan Yu & Junhao Jiang & Jiaxin Yang & Lu Chen & Zhangyou Yang & Chao Yu, 2022. "Small molecule-assisted assembly of multifunctional ceria nanozymes for synergistic treatment of atherosclerosis," Nature Communications, Nature, vol. 13(1), pages 1-14, December.
    2. Weifeng Pan & Lijing Gong & Guoan Xiao & Lantian Zhang & Yiran Xiao & Chunyan Xu, 2022. "Regular Tennis Exercise May Improve the Vascular Endothelial Function in Postmenopausal Women: The Influence of Hemodynamics," IJERPH, MDPI, vol. 19(23), pages 1-15, November.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:nat:nature:v:592:y:2021:i:7855:d:10.1038_s41586-021-03392-8. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    We have no bibliographic references for this item. You can help adding them by using this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Sonal Shukla or Springer Nature Abstracting and Indexing (email available below). General contact details of provider: http://www.nature.com .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.