The continuum of cardiovascular vulnerability: From premature atherosclerosis to heavily calcified lesions
Year: 2026
Type: editorial
Abstract: Coronary atherosclerosis encompasses premature clinical events and heavily calcified lesions that complicate percutaneous coronary intervention (PCI). This editorial examines overlapping biological and procedural vulnerabilities and implications for prevention and intervention. Cumulative exposure to apolipoprotein B-containing lipoproteins, alongside inherited and acquired risk factors, drives atherosclerosis. Plaque inflammation, disruption, healing, fibrosis, and mineralization are dynamic processes, not an inevitable linear sequence. Biological vulnerability concerns the propensity for rupture, erosion, and thrombosis; procedural vulnerability concerns treatment complexity and complications when PCI is clinically indicated. Calcified nodules may confer both forms of vulnerability. Macrocalcification may reflect an adaptive healing response that stabilizes plaques, whereas microcalcification may promote vulnerability. Extensive coronary calcium nevertheless marks cumulative atherosclerotic burden, and lesion calcification complicates PCI. Risk assessment should integrate systemic risk, plaque burden, morphology, and clinical context. Intensive lipid lowering, risk-factor control, and adherence remain essential. Coronary imaging can refine risk assessment and guide lesion preparation, but neither high-risk plaque features nor heavy calcification alone establishes an indication for PCI. In PREVENT, preventive PCI plus optimal medical therapy reduced a composite endpoint in selected patients with non-flow-limiting, imaging-defined high-risk plaques; this does not establish a definitive reduction in death or spontaneous myocardial infarction. Indonesian priorities include earlier recognition of severe hypercholesterolemia, tobacco control, access to lipid-lowering therapy, and follow-up. Conclusion: This continuum supports lifelong prevention and selectively indicated, imaging-informed intervention, prioritizing patient outcomes over plaque detection or stent implantation. Keyword : Atherosclerosis; Atherosclerotic; Plaque; Percutaneous Coronary Intervention; Risk Assessment; Vascular Calcification.
Source: Heart Science Journal
Author: Muhammad Munawar
Institution: Rumah Sakit Jantung Binawaluya
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W7221770864