Mechanisms of Atherosclerosis in Metabolic Syndrome: From Bench to Bedside

Last two decades witnessed the remarkable progress of the understanding of the pathogenesis of atherosclerosis. The concept that low density lipoprotein (LDL) plays an essential role in the initiation and progression of the atherosclerosis has been proposed and indeed this concept has been proved by a number of randomized clinical trials (RCT) with statins. However, the prevention of the cardiovascular (CV) events in the patients with metabolic syndrome (MetS) and type 2 diabetes mellitus (T2DM) remains challenging because statins fail to completely reverse the increased risk of CV events in subjects with these metabolic diseases. Several potential mechanisms are under discussion to explain residual risk, including insulin resistance, dyslipidemia characterized by high levels of triglyceride, low levels of HDL-C, and the appearance of small dense LDL and low adiponectin levels. It is becoming clear that imaging modalities of the plaques including intravascular ultrasound (IVUS), optical coherence tomography (OCT), multi-detector CT (MDCT), and magnetic resonance imaging (MRI) and large scale clinical trials fueled the knowledge about the pathophysiology and clinical features of the atherosclerosis in the patients with MetS and T2DM. In this symposium, we will discuss emerging concept and questions raised by the recent research focusing on various aspects of atherosclerosis, to contribute to the future development of a better mechanistic understanding, and eventually, to develop the novel strategies of prevention and treatment for such a rapidly increasing atherosclerotic cardiovascular disease.