A new paradigm to reduce cardiovascular disease based on the pathogenesis of atherosclerosis.

Atherosclerotic coronary artery disease is the number one cause of morbidity and mortality in the United States, Europe, and Westernized countries. This review recommends a new paradigm for the reduction of atherosclerotic coronary artery disease, namely prevention and treatment by addressing the pathophysiological basis of atherosclerotic disease. This paradigm utilizes the role of cholesterol transport and inflammatory cytokines to reverse atherosclerosis. There are three principal pathogenic processes involved in the development of atherosclerotic arterial plaque formation: 1) arterial endothelial disruption, 2) cholesterol subendothelial deposition and 3) inflammation. Pharmacological treatment is reserved for individuals with proven atherosclerosis. This targeted approach is both cost-effective and widely available. Using both circulating low density lipoprotein cholesterol (and/or other transport lipids) and C reactive protein to monitor cholesterol flux and inflammation respectively, provides on-going insight into the beneficial effects of therapy. Employing the pathophysiology of atherosclerosis as a guideline to treat coronary artery disease in place of computer-based risk equations will greatly decrease the epidemic of cardiovascular disease and move medical practice forward toward the eradication of this global syndemic.