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Mechanisms, precision therapies, and technological frontiers in coronary atherosclerosis: a comprehensive review

Acta Pharmacologica Sinica (2026)Cite this article

Abstract

Coronary atherosclerosis is a leading cause of morbidity and mortality worldwide and is characterized by complex molecular and cellular mechanisms involving lipid dysregulation, endothelial dysfunction, immune-inflammatory processes, and vascular remodeling. Despite advancements in conventional therapies, including statins and antiplatelet agents, significant residual risk persists, particularly in patients with genetic dyslipidemias, persistent inflammation, or limited access to advanced care. Recent breakthroughs in precision medicine, multiomics technologies, and high-resolution imaging are transforming our approach to cardiovascular risk assessment by enabling refined stratification through single-cell transcriptomics, polygenic risk scoring, and artificial intelligence-powered plaque analysis. This review synthesizes the contemporary understanding of disease mechanisms and emerging therapeutic strategies, highlighting novel interventions targeting PCSK, inflammatory pathways, and vascular regeneration through cell-based therapies. We further explored the transformative potential of CRISPR-Cas9 gene editing for durable lipid lowering, nanotechnology-enabled drug delivery, and gut microbiota modulation targeting metabolites such as trimethylamine N-oxide. Although these innovations promise personalized atherosclerosis management, challenges remain in terms of accessibility, health equity, and clinical implementation. The integration of multimodal data analytics with targeted therapeutics heralds a new era of precision cardiology aimed at reducing the global burden of coronary artery disease.

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Fig. 1: Pathophysiological mechanisms in coronary atherosclerosis.

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Acknowledgements

This study was supported by the “Pioneer” and “Leading Goose” R&D Program of Zhejiang province (2024C03144 to ZFX); the Hangzhou Joint Fund of the Zhejiang Provincial Natural Science Foundation of China (LHZY24H020001 to RYH), and the Medical Science and Technology Planning Project of Zhejiang Province (No.2024KY1366 to RYH).

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Authors and Affiliations

  1. Center for Drug Safety Evaluation and Research of Zhejiang University, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, 310058, China

    Zi-xuan Qiu, Ruo-yu Wang, Yi Zhang, Hao Yan, Pei-hua Luo, Zhi-fei Xu & Qiao-jun He

  2. Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC, Australia

    Han-bing Huang

  3. Department of Pharmaceutical Preparation, Hangzhou Xixi Hospital, Hangzhou, Zhejiang, China

    Ruo-yu He

  4. Innovation Institute for Artificial Intelligence in Medicine of Zhejiang University, Hangzhou, Zhejiang, China

    Pei-hua Luo, Bo Yang & Qiao-jun He

  5. Institute of Pharmacology & Toxicology, Zhejiang Key Laboratory of Anti-Cancer Drug Research, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, 310058, China

    Bo Yang

  6. School of Medicine, Hangzhou City University, Hangzhou, Zhejiang, China

    Bo Yang & Qiao-jun He

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  1. Zi-xuan Qiu
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  2. Ruo-yu Wang
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  3. Yi Zhang
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  9. Zhi-fei Xu
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Contributions

ZXQ: Conceptualization, Literature review, Writing – original draft, Visualization. RYW: Literature review, Data curation, Writing – original draft. YZ: Methodology, Validation, Writing – review & editing. HBH: Writing – review & editing, Visualization. RYH: Writing – review & editing, Funding acquisition. HY: Investigation, Formal analysis, Writing – review & editing. PHL: Resources, Supervision, Writing – review & editing. BY: Methodology, Project administration. ZFX: Supervision, Project administration, Writing – review & editing, Funding acquisition. QJH: Conceptualization, Supervision, Writing – review & editing.

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Correspondence to Zhi-fei Xu or Qiao-jun He.

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Prof. Bo Yang is the editorial board member of the journal and was not involved in the peer review or the decision making of the article. The authors declare no other competing interests.

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Qiu, Zx., Wang, Ry., Zhang, Y. et al. Mechanisms, precision therapies, and technological frontiers in coronary atherosclerosis: a comprehensive review. Acta Pharmacol Sin (2026). https://doi.org/10.1038/s41401-025-01729-x

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