From risk factor modification to arterial-centered therapy: advancing a paradigm shift in atherosclerosis management

Atherosclerotic cardiovascular disease (ASCVD) remains a major cause of morbidity and mortality globally. Traditional risk factors such as hypertension, smoking, and hypercholesterolemia are essential in prevention, but fail to fully capture the complexity of coronary artery disease (CAD) progression. This opinion advocates for shifting from risk factor-based models to an atherosclerosis-centered approach, focusing on coronary plaque assessment. Recent studies show that coronary computed tomography angiography (CTA) improves risk stratification and treatment decision-making. Advanced imaging and artificial intelligence tools allow better plaque quantification and risk prediction, enhancing precision medicine. Although further randomized trials are needed, integrating coronary CTA in clinical practice holds the potential to optimize prevention and reduce cardiovascular events and healthcare costs.