Primary prevention of coronary artery disease: let's start with calcium score

The CLIMA study: assessing the risk of myocardial infarction with a new anatomical score

Atherosclerosis is a chronic degenerative disease, with a significant inflammatory component, characterized by phases of rapid activation leading to important clinical events, such as myocardial infarction. One of the major challenges of modern cardiology is limiting the progression of atherosclerotic disease and anticipating the phases of instability as to limit its consequences. In this contest modern techniques of intra-coronary imaging, such as optical coherence tomography, could have a pivotal role in identifying patients at higher risk of acute events in the short term. The purpose of the CLIMA study is to identify and map the vulnerability criteria of atherosclerotic coronary plaques in the individual patient, and provide a personalized risk score for coronary events.

'Precision medicine' and ischaemic heart disease: the stage is set for the new antibody based therapies (lipid lowering and anti-inflammatory)

Improving cardiovascular risk assessment requires a 'personalized' approach. Appraisal of well-known cardiovascular risk factors should be integrated with markers of cardiovascular risk such as LDL cholesterol (C-LDL) and C-reactive protein (CRP). Results of the recent trials of PCSK9 inhibitor monoclonal antibodies open new interesting perspective. Data regarding the use of Evolocumab, in secondary prevention settings, in high-risk patients are very encouraging. In the same vein, the CANTOS study demonstrated, for the first time, that Canakinumbab, an antibody with anti-inflammatory action (with no effects on C-LDL levels), decreases significantly the risk of major cardiovascular events in a high-risk population with elevated CRP and optimal C-LDL. This trial, for the first time, suggested a strategy distinguishing the anti-inflammatory from the cholesterol lowering component, thus differentiating the treatment. In the ensuing years, we will probably witness the clinical application of this concept.