Atherosclerosis and Coronary Artery Disease: Mechanisms, Risk Stratification, and Novel Therapies

This chapter provides a detailed review of the cellular and molecular mechanisms driving atherosclerosis initiation, progression, and plaque destabilization, with emphasis on the roles of inflammation, lipid metabolism, endothelial dysfunction, and clonal haematopoiesis. It critically appraises contemporary approaches to cardiovascular risk stratification — including polygenic risk scores, coronary calcium scoring, and advanced lipid biomarkers — alongside established frameworks. The chapter also examines the pharmacological frontier, including PCSK9 inhibitors, inclisiran, bempedoic acid, colchicine, and anti-inflammatory biologics entering or recently validated in cardiovascular trials.