Atherosclerosis is the buildup of fatty deposits in artery walls, narrowing blood vessels and raising the risk of heart attack and stroke. It's widespread — about half of adults over 45 have some degree of plaque in their arteries. Treatment centers on statins, blood pressure control, and lifestyle changes, with procedures like stents or bypass surgery for severe blockages.
What's actually going on in research
Trials are testing drugs that target inflammation in artery walls, novel cholesterol-lowering agents beyond statins, therapies to stabilize or even reverse existing plaque, and ways to predict who faces the highest risk. PCSK9 inhibitors like evolocumab and alirocumab are FDA-approved and drop LDL cholesterol dramatically. Researchers are also studying the gut microbiome's role and how metabolic disease accelerates plaque formation.
Anti-inflammatory drugs
Trials are testing whether drugs that reduce artery-wall inflammation can prevent heart attacks independently of cholesterol lowering. Colchicine, an old gout drug, showed benefit in one large trial and is now used by some cardiologists.
Plaque reversal
Researchers are testing whether aggressive cholesterol lowering with newer drugs can shrink existing plaques. Imaging studies suggest some regression is possible, though whether this translates to fewer events is still being studied.
RNA-based therapies
Injections that silence genes controlling cholesterol production are in trials. Inclisiran, approved in 2021, requires dosing just twice a year and keeps LDL low for months.
What to know before you search
Eligibility typically depends on cholesterol levels, history of heart attack or stroke, presence of diabetes, and whether current medications have brought cholesterol to target.
What types of trials are currently open
- Cholesterol-lowering trials — Testing new drugs that reduce LDL cholesterol, often in people who can't tolerate statins or need deeper reduction. These include PCSK9 inhibitors, bempedoic acid, and gene-silencing therapies.
- Inflammation trials — Testing drugs that calm inflammation in artery walls, based on evidence that inflammation drives plaque rupture and heart attacks.
- Imaging studies — Using CT scans or ultrasound to measure whether treatments slow plaque growth or cause regression. These studies track artery changes over one to two years.
- Prevention trials — Testing whether drugs or lifestyle interventions prevent heart attacks and strokes in people with atherosclerosis but no prior events.
- Biomarker studies — Following people with atherosclerosis to identify blood tests or imaging findings that predict future heart attacks, aiming to guide treatment intensity.
Recently added Atherosclerosis trials
Comparison of Clopidogrel-based Antiplatelet Agent Treatment and Aspirin Plus Low Dose Rivaroxaban Therapy
The study aims to conduct a randomized controlled trial among adults aged 19 years or older who have experienced acute myocardial infarction at least one year prior, or who have other comorbidities such as peripheral arterial disease or multiple cardiovascular diseases, and have consented to participate in the study. Participants will be randomly assigned to either a group that maintains antiplatelet therapy with aspirin and clopidogrel or clopidogrel alone, or a group that maintains combined antiplatelet and anticoagulant therapy with aspirin and low-dose rivaroxaban in a 1:1 ratio. The study aims to demonstrate that maintaining clopidogrel-based antiplatelet therapy is not clinically inferior to maintaining combined therapy with aspirin and low-dose rivaroxaban.
Share blood samples to help researchers understand heart attacks
Coronary artery disease is one of the most common causes of illness and death. It develops when fatty deposits, known as plaques, build up in the arteries that supply blood to the heart. These plaques can gradually narrow the arteries and reduce blood flow, causing symptoms such as chest pain (angina). Sometimes a plaque can suddenly break open, causing a blood clot to form and block the artery. This can lead to a heart attack and permanent damage to the heart muscle. Although much has been learned about coronary artery disease, important questions remain about why some plaques suddenly become unstable, how this affects blood flow through the smallest blood vessels of the heart, and why some patients develop more heart muscle damage than others. The Oxford Acute Myocardial Infarction (OxAMI) research programme aims to improve our understanding of these processes. The investigators will study both the disease within the coronary arteries (the "upstream" problem) and its effects on the heart muscle (the "downstream" damage). By examining these together, the investigators hope to understand more clearly how changes in coronary plaques lead to heart injury and how this differs between patients. Participants undergoing procedures to investigate or treat coronary artery disease provide an important opportunity to study these processes. During coronary angioplasty (also called percutaneous coronary intervention or PCI), a narrow or blocked artery is opened, usually using a small balloon and a stent. This procedure can disturb the underlying plaque in a similar way to the plaque disruption that occurs during a heart attack. Where appropriate, the investigators may therefore collect blood and material released from the plaque during these procedures. Blood may be collected from different locations in the circulation, allowing the investigators to study substances released by the plaque and heart muscle. Material that would otherwise be discarded during treatment may also be collected for laboratory analysis. The investigators will use several established and newer techniques to examine the coronary arteries, the small blood vessels within the heart, and the heart muscle. These may include detailed imaging from inside the coronary arteries using intravascular ultrasound (IVUS) or optical coherence tomography (OCT). The investigators may also measure blood pressure and flow within the coronary arteries to assess how well the small blood vessels supplying the heart are working. Non-invasive heart scans may include cardiovascular magnetic resonance (CMR/MRI), cardiac computed tomography (CT) and echocardiography (ultrasound). These techniques can provide detailed information about the structure and function of the heart, blood supply to the heart muscle, areas of injury or permanent scarring, and changes that occur following a heart attack. In particular, MRI may help distinguish heart muscle that has been permanently damaged from muscle that is injured but could potentially recover after blood flow is restored. This may be especially important for participants who arrive at hospital several hours after their heart attack began. Other measurements may include electrocardiograms (ECGs), which record the electrical activity of the heart, and measurements of heart pressure, volume and function. Some participants may also have longer-term ECG monitoring. Blood and tissue samples may be analysed using a range of laboratory techniques. These studies will investigate inflammation, blood clotting and other biological processes involved in coronary artery disease and heart attacks. Newer laboratory methods may allow us to measure large numbers of proteins and small molecules in the blood. Material collected from plaques may also be examined under a microscope to identify its cells and structural components. With additional consent, blood samples may be stored for genetic research. This could help us understand whether differences in people's genes influence their risk of coronary artery disease, their response to a heart attack, or the amount of heart damage that occurs. By combining information about coronary plaques, blood flow through the heart's circulation, heart muscle injury, imaging, blood and tissue markers, and genetic factors, the OxAMI study aims to build a detailed picture of coronary artery disease and heart attacks. The programme will establish a carefully characterised group of research participants who may contribute to future OxAMI studies conducted under separate research protocols. Ultimately, this research aims to identify better ways to predict, diagnose and understand coronary artery disease and heart attacks, and to identify new approaches that could improve treatment and outcomes for future patients.
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