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

https://www.thelancet.com/commissions/coronary-artery-disease?dgcid=hubspot_email_conferencealerts_acc25_lancetcad25&utm_campaign=conferencealerts&utm_medium=email&_hsenc=p2ANqtz-9VDqsCzh69wAnXZ9MSOyFzG3Gzmd67i7Am2FaZY2gWe_cwp-34pMUqrOXAbr1KYJIjO_UA9PaCXTKw-H4i1NkAZ_EOwg&_hsmi=354063385&utm_content=354063385&utm_source=hs_email For decades, the management of coronary artery disease has focused on epicardial obstruction and ischaemia, which is often recognised too late for long-term intervention. This approach limits the potential for effective intervention, which particularly concerning because coronary artery disease remains a leading cause of global morbidity and mortality. Current cardiovascular care emphasises restoration of blood flow rather than prevention of disease progression. Despite significant health-care spending on ischaemia, the primary mechanisms of myocardial infarction—atherosclerotic plaque rupture and erosion—often occur earlier in the disease process. The Lancet Commission aims to redefine coronary artery disease by shifting the focus from ischaemic heart disease to atherosclerotic coronary artery disease, emphasising early detection, management of risk factors, and a comprehensive approach to prevention throughout the life course.