Coronary artery disease (CAD) is a complex condition resulting from the interplay of behavioral, environmental, and genetic factors. While modifiable risk factors like smoking and hypertension are well-recognized, recent large-scale genomic studies have identified hundreds of genetic variants that significantly influence susceptibility. This inherited basis manifests in two primary forms: rare monogenic variants with large effects (such as familial hypercholesterolemia) and a broad polygenic architecture composed of common variants with small individual effects.

The integration of polygenic risk scores (PRS) into clinical practice offers a mechanism to refine risk prediction, particularly for younger individuals and those with intermediate clinical risk. Furthermore, genetic insights have validated several contemporary therapeutic targets and prioritized new pathways for drug development. Despite these advances, challenges remain regarding the standardization of genetic scores, equitable access across diverse ancestries, and the determination of cost-effectiveness in routine clinical implementation.

If you have following burning questions, then this podcast is worth listening.

1/ What is the importance of genetics in CAD ?

2/ If family history of CAD is negative, does it confers safety to the offsprings ?

3/ Can we diagnose the risk of future CAD at birth by genetic tests ?

4/ If the genetic risk of CAD is high, can we modify it by lifestyle changes ?

5/ Are there medicines to affect genetic susceptibility for CAD ?

This podcast is based on the latest article " The Inherited Basis of Coronary Artery Disease" by Dr Pradeep Natarajan etal Center for Genomic Medicine and Cardiovascular Research Center, Massachusetts General Hospital, Boston. Published in NEJM.

N Engl J Med 2026;394:576-87.

DOI: 10.1056/NEJMra2405153

This podcast examines the unique biological resilience of the internal mammary artery (IMA), which remains remarkably resistant to atherosclerosis despite being exposed to the same systemic risks as other vessels. While traditional risk factors drive disease in most arteries, the IMA possesses specialized endothelial properties, including high nitric oxide production and a robust internal elastic lamina, that prevent plaque buildup. Its anatomical structure promotes stable anterograde blood flow, fostering an anti-inflammatory environment that preserves vascular health even during the aging process. Because of these protective qualities, the IMA is the preferred conduit for bypass surgery, demonstrating superior long-term survival rates compared to vein grafts. By shifting the medical focus from systemic risks to these localized mechanisms of resistance, researchers hope to discover novel therapeutic targets to treat cardiovascular disease. The text emphasizes that understanding why this specific artery "bounces back" from injury could revolutionize how we address unmet medical needs in heart health.

This podcast is based on the excellent article " Resilience of the Internal Mammary Artery to Atherogenesis: Shifting From Risk to Resistance to Address Unmet Needs" by Kraler et al. published in Journal Arteriosclerosis, Thrombosis, and Vascular Biology

Arterioscler Thromb Vasc Biol. 2021;41:2237–2251. DOI: 10.1161/ATVBAHA.121.316256

Welcome to Cardio Deep Dive latest episode. In today’s episode we focus on vulnerable plaque: the high-risk atherosclerotic lesion characterized by a thin fibrous cap, large lipid core and intense inflammation that predisposes to rupture, thrombosis, and acute coronary syndromes despite often minimal stenosis. We’ll explore its pathophysiology, clinical significance, and evolving imaging and management strategies to better prevent sudden cardiac events.