ADENOSINE IN CARDIOVASCULAR PHYSIOLOGY: MULTIFACETED ROLES IN CORONARY VASODILATION, ATHEROPROTECTION, AND PLATELET REGULATION

This review delves into various aspects of acute coronary syndrome (ACS), emphasizing recent advancements. Despite progress, ACS remains a major global health concern. The classical view linking coronary stenoses to chronic syndrome is challenged, with optimal medical therapy often showing better outcomes. Diverse ACS mechanisms include plaque rupture, calcified nodules, spontaneous dissection of the coronary arteries, and coronary artery spasm. Immune factors, particularly neutrophils and their extracellular traps, play a dual role in both inflammation and tissue healing. The adaptive immune response involving T and B lymphocytes adds complexity. Metabolic and lipid-related factors like adenosine pathways, vitamin D, and lipoprotein-associated phospholipase A2 impact atherothrombotic processes. Non-coding RNAs, including circular, long, and microRNAs contribute to ACS. Genic therapies like Olpasiran and Inclisiran show promise in targeting specific molecular pathways to reduce cardiovascular risk factors. Overall, this review offers a comprehensive understanding of ACS, incorporating recent molecular, immunological, and therapeutic advances, highlighting the need for ongoing research to improve diagnostic and treatment strategies.