Atherosclerosis. 2026 May 24:120787. doi: 10.1016/j.atherosclerosis.2026.120787. Online ahead of print.
ABSTRACT
Atherosclerotic cardiovascular disease (ASCVD) is a leading cause of death, with substantial residual risk persisting despite current lipid-lowering, antithrombotic, antihypertensive, weight-management, and anti-inflammatory therapies. This unmet clinical need reflects the multifactorial and heterogeneous nature of ASCVD, which is not fully captured by traditional discovery approaches. Recent advances in large-scale datasets, multi-omics technologies, polygenic risk scores, and artificial intelligence offer unprecedented opportunities to disentangle disease complexity and identify novel therapeutic targets and biomarkers. However, translation into clinically actionable strategies requires robust validation in models that faithfully recapitulate human disease. Conventional two-dimensional cell cultures and standard murine models have provided important mechanistic insights but often fail to reflect human-specific features such as lipid metabolism, hemodynamics, and plaque destabilization. To address these limitations, advanced in vitro and ex vivo platforms are emerging, including induced pluripotent stem cell-derived vascular systems, microphysiological vessel-on-chip devices, vascularized organoids, and ex vivo human tissue models. These systems offer controlled, human-relevant microenvironments for scalable perturbation testing and support personalized therapeutic development. Nevertheless, in vivo models remain essential for capturing systemic physiology, inter-organ crosstalk, and pharmacokinetic and pharmacodynamic responses, underscoring the need for complementary, rather than replacement, use of model systems. In this review, we propose an integrated framework linking data-driven target and biomarker discovery to validation in human-relevant experimental models, supported by selective use of in vivo systems. By aligning multi-omics and AI-based discovery with advanced preclinical platforms, this approach aims to improve translational success and accelerate the development of precision therapies for ASCVD.
PMID:42177118 | DOI:10.1016/j.atherosclerosis.2026.120787