ASCVD

Atherosclerotic cardiovascular disease (ASCVD) is a group of conditions caused by atherosclerosis, the buildup of lipid-rich plaques in arterial walls that narrows and stiffens vessels. ASCVD commonly affects the coronary arteries, the arteries of the brain and carotid system, and the peripheral arteries, leading to coronary artery disease, cerebrovascular disease, and peripheral artery disease.

Atherosclerosis involves lipid accumulation, inflammation, plaque formation, rupture, and thrombosis. Major risk factors include both non-modifiable and modifiable factors: age, male sex, family history, hypertension, dyslipidemia, diabetes, smoking, obesity, and sedentary lifestyle. Chronic kidney disease and inflammatory conditions can also contribute.

Diagnosis combines clinical assessment with imaging and risk estimation. Tests may include electrocardiography, stress testing, coronary angiography, carotid duplex ultrasound, and the ankle-brachial index. Overall ASCVD risk is estimated with models such as the 10-year ASCVD risk calculator to guide preventive therapies, with regional guideline variations.

Management emphasizes prevention and reduction of risk factors. Primary prevention relies on lifestyle modification and lipid, blood pressure, and glucose control; statin therapy is a cornerstone for lowering low-density lipoprotein cholesterol. In secondary prevention, antiplatelet therapy is commonly used, and more intensive lipid lowering (ezetimibe, PCSK9 inhibitors) may be added. Revascularization is considered for selected cases, such as significant coronary, carotid, or peripheral artery disease.

ASCVD remains a leading cause of cardiovascular morbidity and mortality worldwide. Advances in risk assessment and guideline-directed therapy aim to reduce recurrent events and improve life expectancy through comprehensive lifestyle and pharmacologic interventions.