The Lancet Commission On Rethinking Coronary Artery Disease Moving From Ischaemia To Atheroma Sarah Zaman by Sarah Zaman, Jason H Wasfy, Vikas Kapil, Boback Ziaeian 101016/S01406736(25)000558 instant download after payment.

Executive summaryOur goals should not just to be to manage symptoms and Coronary artery disease has long been understood events but to prevent the disease from developing in the March 31, 2025through the paradigm of epicardial coronary artery first place and, where possible, reverse its course. causing myocardial ischaemia (a mismatch S0140-6736(25)00055-8between myocardial blood supply and demand). Early detection and prevention of ACADSee Comment page 1209However, this model, which focuses on diagnosing and The prevention of ACAD must begin with early detection Westmead Applied Research managing coronary artery disease based on ischaemia and modification of risk factors. If behavioural and Centre, Faculty of Medicine and and cardiovascular events, is flawed. By the time metabolic risk factors, such as smoking, hypertension, Health, University of Sydney, ischaemia manifests, it is often too late for optimal high cholesterol, and poor diet, were eliminated or Sydney, NSW, Australia(S Zaman MD PhD); Department intervention, limiting the effectiveness of treatment controlled early in life, the global burden of ACAD could of Cardiology, Westmead options. Despite decades of medical advances, coronary be dramatically reduced. Eliminating these risk factors Hospital, Sydney, NSW, artery disease continues to be a leading cause of by 2050 could decrease the rate of ACAD deaths by Australia (S Zaman); morbidity and mortality globally, highlighting the 82·1%, potentially saving 8·7 million lives annually. Massachusetts General Hospital, Boston, MA, USAinadequacy of this traditional ischaemia-centric model.Public health initiatives should emphasise lifestyle (J H Wasfy MD PhD); Harvard The central limitation of current approaches is the focus changes and the management of metabolic disorders to Medical School, Boston, MA, on the temporary solutions of restoring myocardial blood prevent the onset of atherosclerosis.USA (J H Wasfy); William Harvey flow after obstruction, rather than tackling the underlying Early detection and effective prevention remain a Research Institute, Centre for Cardiovascular Medicine and disease. Coronary artery disease, caused by atherosclerosis, challenge. The implementation of screening strategies to Devices, NIHR Barts Biomedical often results in myocardial infarction through identify individuals at risk of developing ACAD is crucial. Research Centre, Queen Mary mechanisms that emerge earlier in the progression of Targeted screening programmes, integrated into healthUniversity of London, disease. The focus of medical care has predominantly care systems, can detect early signs of atherosclerosis St Bartholomew’s Hospital, London, UK (V Kapil MD PhD); been on the recognition of symptoms and treatment of and enable timely intervention. Such interventions, if Division of Cardiology, David acute events, missing opportunities for early detection applied early, have the potential to halt, delay, or even Geffen School of Medicine at and prevention of disease. Billions of dollars in health-care reverse the progress of the disease, reducing the risk of UCLA, University of California, Los Angeles, CA, USAfunding continue to be spent on identifying and managing cardiovascular events in later life.(B Ziaeian MD PhD); Australian coronary ischaemia; yet, the dominant mechanisms for Centre for Health Services myocardial infarction are atherosclerotic plaque rupture Addressing the global burden of ACADInnovation, Queensland or erosion and, to a lesser extent, erupted calcified nodules ACAD is not a uniform problem across the globe. University of Technology,Brisbane, QLD, Australiathat can emerge at a much earlier stage of the disease.(Prof W A Parsonage MD); This Commission advocates for a shift in the conceptualDepartment of Cardiology, framework of coronary artery disease. We suggestRoyal Brisbane and Women’s reclassifying the condition as atherosclerotic coronaryHospital, Brisbane, QLD, Australia (Prof W A Parsonage); artery disease (ACAD), moving away from the traditionalCenter of Excellence in emphasis on ischaemia and acute cardiac events towardsComputational Molecular a more systematic understanding of atherosclerosis. ThisBiology, Chulalongkorn reframing will enable the identification and managementUniversity, Pathum Wan, Bangkok, Thailandof the disease much earlier in its course, potentially(S Sriswasdi PhD); Faculty of saving millions of lives worldwide.Medicine, Chulalongkorn Risk of ACAD develops over a lifetime, beginning inUniversity, Pathum Wan, utero, progressing through childhood and adolescenceBangkok, Thailand(S Sriswasdi); School of and continuing into older age. The early stages of diseaseMedicine and Population which involve the formation of atherosclerotic plaquesHealth, University of Sheffield, are often undetected. A major shift is needed from acuteSheffield, UKevent-centred care to strategies focused on early(Prof T J A Chico MD); British Heart Foundation Data Science diagnosis, prevention, and management ofCentre, Health Data Research atherosclerosis. In this new framework, ACAD should beUK, London, UKrecognised across all stages, from the earliest signs of(Prof T J A Chico); Division of atheroma formation to the advanced stages of diseaseCardiology, Azienda