Pulse Brain · Growing Health Evidence Index
Tier 4 — Narrative / commentaryPeer-reviewed

The Lancet Commission on rethinking coronary artery disease: moving from ischaemia to atheroma.

Zaman S, Wasfy JH, Kapil V, Ziaeian B, Parsonage WA, Sriswasdi S, Chico TJA, Capodanno D, Colleran R, Sutton NR, Song L, Karam N, Sofat R, Fraccaro C, Chamié D, Alasnag M, Warisawa T, Gonzalo N, Jomaa W, Mehta SR, Cook EES, Sundström J, Nicholls SJ, Shaw LJ, Patel MR, Al-Lamee RK.

Lancet · 2025

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Summary

This Lancet Commission paper argues for a paradigm shift in the understanding and management of coronary artery disease, moving away from ischaemia as the primary therapeutic target towards the identification and treatment of atherosclerotic plaque. Drawing on a large multidisciplinary international authorship, the commission likely synthesises evidence from imaging, interventional, and pharmacological studies to support this reframing. The work has potential implications for clinical practice guidelines, diagnostic pathways, and the prioritisation of lipid-lowering and anti-inflammatory therapies.

UK applicability

The commission's recommendations are broadly applicable to UK clinical practice, particularly within NHS cardiology services and NICE guideline development, given the UK's substantial burden of coronary artery disease and existing investment in cardiac imaging infrastructure.

Key measures

Cardiovascular event rates; atherosclerotic plaque burden; ischaemic burden; diagnostic accuracy metrics; clinical outcome data from reviewed trials

Outcomes reported

The commission examined the evidence base for reframing coronary artery disease management around atherosclerotic plaque (atheroma) rather than ischaemia, likely reporting on diagnostic strategies, treatment outcomes, and implications for clinical guidelines. It is expected to assess how an atheroma-centred approach affects patient outcomes including cardiovascular events and mortality.

Theme
Nutrition & health
Subject
Cardiovascular disease & clinical cardiology
Study type
Narrative Review
Study design
Narrative review
Source type
Peer-reviewed study
Status
Published
Geography
International
System type
Human clinical
DOI
10.1016/s0140-6736(25)00055-8
Catalogue ID
NRmo3f02hq-0by

Topic tags

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