Accelerated Atherosclerosis

Accelerated atherosclerosis (AA) denotes a disproportionately early and rapid progression of arterial atheroma unpredictable by standard tools. Clinicians often rely on simplified frameworks for cardiovascular risk assessment, which may overlook genetic and pathological conditions associated with AA. Some of these are well established, others are considered future therapy targets. This review examines the conditions in which AA is most firmly established, including rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), antiphospholipid syndrome, chronic kidney disease (CKD), human immunodeficiency virus (HIV), diabetes mellitus, and psoriasis. We also examined the importance of genetic determinants of AA, with particular emphasis on clonal hematopoiesis of indeterminate potential (CHIP) and lipoprotein (a) (Lp(a)); contemporary imaging-based detection and monitoring; the diagnostic role of circulating non-coding microRNAs; and complementary protein biomarkers of residual inflammatory risk. After identifying biomarkers of increased cardiovascular risk and possible AA, clinicians should assess atherosclerotic disease directly using the available imaging techniques, most of which are non-invasive. The clinical consequences of AA are discussed and a comprehensive review of the therapeutic options is provided to offer a practical approach.