Personalized Intervention Based on Early Detection of Atherosclerosis: JACC State-of-the-Art Review.

Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality worldwide and challenges the capacity of health care systems globally. Atherosclerosis is the underlying pathophysiological entity in two-thirds of patients with CVD. When considering that atherosclerosis develops over decades, there is potentially great opportunity for prevention of associated events such as myocardial infarction and stroke. Subclinical atherosclerosis has been identified in its early stages in young individuals; however, there is no consensus on how to prevent progression to symptomatic disease. Given the growing burden of CVD, a paradigm shift is required-moving from late management of atherosclerotic CVD to earlier detection during the subclinical phase with the goal of potential cure or prevention of events. Studies must focus on how precision medicine using imaging and circulating biomarkers may identify atherosclerosis earlier and determine whether such a paradigm shift would lead to overall cost savings for global health.

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Funding Support and Author Disclosures Funding was provided by Novo Nordisk Foundation, Hellerup, Denmark. Dr Johri has received honoraria from Novo Nordisk, BMS, and Janssen; and has received research support from Philips, GE Healthcare, and Lantheus. Dr Nordestgaard has received consultancies and/or given talks for AstraZeneca, Sanofi, Regeneron, Ionis, Amgen, Kowa, Denka, Amarin, Novartis, Novo Nordisk, Esperion, Abbott, Silence Therapeutics, Ultragenyx, USV, Mankind, Lilly, Arrowhead, and Marea. Dr MacRae has received grants from the National Institutes of Health and the American Heart Association (One Brave Idea, Apple Heart, and Movement Study) and Samsung; has consultancies with Bayer, Biosymetrics, Clarify Health, Dewpoint Therapeutics, Dinaqor, Dr Evidence, Foresite Labs, Insmed, Pfizer, and Platform Life Sciences; and is a co-founder of Atman Health and Tanaist. Dr Kofoed has received research grants from AP Møller and wife Chastine McKinney Møllers Foundation, The Novo Nordisk Foundation, Sygeforsikringen Danmark, Research Council of Rigshopitalet, The University of Copenhagen, Canon Medical Systems, and GE Healthcare. Dr Bøttcher has participated on the advisory board for AstraZeneca, Bayer, Boehringer Ingelheim, Novartis, Novo Nordisk, and Sanofi. Dr Shapiro has served on the scientific advisory boards for Agepha, Amgen, Ionis, and Novartis; and has been a consultant for Amgen, Ionis, Novartis, Regeneron, and Shanghai Pharma Biotherapeutics. Dr Budoff has received grant support from General Electric. Dr Douglas has received research support from HeartFlow and Caption Health; and has received honoraria from UpToDate and Foresite Labs. Dr Nicholls has received research support from AstraZeneca, Amgen, Anthera, CSL Behring, Cerenis, Eli Lilly, Esperion, Resverlogix, New Amsterdam Pharma, Novartis, InfraReDx, and Sanofi-Regeneron; and has consultancies with Amgen, Akcea, Arrowhead, AstraZeneca, Boehringer Ingelheim, CSL Behring, Eli Lilly, Esperion, Kowa, Merck, Takeda, Pfizer, Sanofi-Regeneron, Vaxxinity, CSL Sequiris, Cyclarity, and Novo Nordisk. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.