ATVB In Focus
Noninvasive Assessment of Atherosclerosis–From Structure to Function
The brief review by Choudhury et al1 in this issue of Arteriosclerosis, Thrombosis, and Vascular Biology is the first in a series of articles intended to highlight emerging technologies for the structural and functional assessment of atherosclerosis. Although many of the techniques have been used in nonhuman models, this series will focus primarily on methods that have proven or show potential utility in human subjects. One reason for choosing this area for a series of focused brief reviews was the aim of the Editors of Arteriosclerosis, Thrombosis, and Vascular Biology to assist the translation of basic scientific advances into the clinical arena.
There have been fundamental advances in our understanding of the genetic, molecular, biochemical, and cellular processes that underlie atherosclerosis, as well as the development of innovative technologies for vascular imaging. Ultimately, these advances should transform the assessment of atherosclerosis in human subjects. A common theme of this series is the recognition that evaluation of atherosclerotic disease must move beyond structural analysis of obstructive lesions toward approaches that use innovative methods to predict plaque rupture. Such approaches will assess specific features that are predictive of plaque stability, including tissue composition, vascular function, and biochemical markers of disease.
This series will include articles on the noninvasive assessment of plaque structure and composition (as in this issue’s review). It will also review techniques that permit assessment of vascular function in vivo, because of the increasing evidence that plaque stability, rather than overall atherosclerotic burden, predicts complications of atherosclerosis. Furthermore, given that development of atherosclerosis depends critically on entry of oxidatively modified lipoproteins into the vessel wall, the series will explore the role of circulating lipoproteins and indices of oxidant stress as predictors of atherosclerosis. Finally, we have invited articles on the use of markers of inflammation and thrombosis in evaluation of risk in atherosclerosis.
The focus on technologies that can be used in human subjects is based on the recognition that most models of atherosclerosis do not reliably reproduce all of the features of human atherosclerosis, particularly plaque rupture. Many of these methods have already provided novel insights into the atherosclerotic process in humans and may in turn stimulate development of mechanistic studies in vitro and in other species (reverse translational research). Ultimately, the approaches outlined in this series are likely to contribute to the development of clinically useful methodologies.