BICCIRE'. Treating the atherosclerotic plaque 2.0

Atherosclerotic cardiovascular disease remains the leading cause of death worldwide, yet our understanding of its biology has evolved more profoundly in the past two decades than in the previous fifty years. Traditional paradigms centred on established clinical scores, ischaemia and flow-limiting stenoses have undoubtedly shaped modern cardiology, but they increasingly revealed intrinsic limitations. Most myocardial infarctions originate from non-obstructive, biologically active plaques that progress silently long before clinical manifestation, and first events frequently occur in individuals classified as low risk by conventional assessment tools. This textbook embraces a modern vision of coronary artery disease, integrating advanced mechanistic knowledge, emerging risk factors, state-of-the-art imaging and contemporary pharmacological strategies to elucidate the underpinnings of modern clinical management of atherosclerosis, from understanding of traditional and non-traditional plaque progression risk factors to defining how these processes can be favourably haltered through targeted interventions. Through contributions from leading experts in cardiovascular medicine, Treating the Atherosclerotic Plaque 2.0 provides a comprehensive and up-to-date synthesis of the groundbreaking evidence that has reshaped our understanding, management and treatment of atherosclerosis. Non-invasive imaging modalities such as coronary computed tomography angiography quantify the burden and phenotype of disease across the entire coronary tree, while intracoronary techniques including IVUS, NIRS and OCT allow for near-histological assessment of plaque composition, inflammation and microstructure. These tools have transformed our capacity to refine risk, identify high-risk individuals and guide therapeutic intensification. Clinical and mechanistic imaging trials have established an almost continuous log-linear association between on-treatment LDL-cholesterol levels and reductions in major cardiovascular events, paralleled by regression of atheroma burden and stabilisation of plaque morphology. Moreover, renewed focus on novel lipid-related biomarkers and residual inflammatory risk is shaping the next frontier of preventive cardiology, offering additional avenues to further reduce the residual risk. This textbook offers clinicians, researchers and trainees a rigorous and practical roadmap to navigate this paradigm shift - from relying only on traditional clinical scores and ischaemia to detecting, characterising and actively modifying atherosclerotic disease. The emerging role of cardiovascular imaging in the management of atherosclerotic coronary artery disease The role of non-invasive imaging to improve risk stratification and guide therapeutic approaches Dyslipidaemias: early diagnosis, risk management and improved outcomes Oral lipid-lowering therapy: the lower, the better with established and novel pharmacological opportunities Strike early, strike strong: rationale for early intensive lipid-lowering therapy in ACS patients Atherosclerotic plaque regression and stabilisation with intensive lipid-lowering therapy Atherosclerotic vulnerable or high-risk plaque: role of invasive treatment Beyond LDL-C lowering: addressing the residual risk Atherosclerosis and atrial fibrillation: a dangerous relationship The relationship between healthcare professionals’ contribution and improvement in cardiovascular patient care and outcomes