Atherosclerosis -- new targets and therapeutics.

Atherosclerosis is well recognized as an inflammatory disease and circulating markers of inflammation such as C-reactive protein and soluble adhesion molecules are strong predictors of atherosclerotic lesion development and future cardiovascular events. Several cells (endothelial, smooth muscle and macrophages) and proteins (inflammatory cytokines and adhesion molecules) contribute to this inflammatory process and lesion development. Although lipid management with statins does reduce levels of circulating inflammatory markers, this appears to be unrelated LDL-lowering. Thus, the recent focus has been shifted to develop molecules that directly affect the atherosclerotic process without effects on plasma lipids. Much of this research was initially focused on cytokine antagonists and adhesion molecule expression inhibitors, which are now at different stages pre-clinical and clinical development. Additional targets have begun gaining prominence in the past few years -- modulation of proteins involved in reverse cholesterol transport and lipid metabolism in the vessel wall such as ApoA1/apoE/ABCA1, ACAT, and LpPLA2 and regulation of molecules involved in matrix remodeling and cell proliferation such as matrix metalloproteinases and heparan sulfate proteoglycans. The current approaches for the treatment of atherosclerosis are 1) reduction of risk factors for the disease -- e.g., lipids, hypertension and diabetes and 2) direct disease modifiers. The purpose of this review is to examine key scientific advances and the prospect of these approaches in the prevention of cardiovascular disease.