Residual cardiovascular risk, use of standard care treatments, and achievement of treatment goals in patients with cardiovascular disease

Siniawski, Daniel; Masson, Gerardo; Masson, Walter; Barbagelata, Leandro; Destaville, Josefina; Lynch, Santiago; Vitagliano, Laura; Parodi, Josefina Belén; Berton, Felipe; Indavere, Agustin; Epstein, Teo; Huerin, Melina

doi:10.1016/j.ijcrp.2023.200198

Cited by 4 publications

(3 citation statements)

References 38 publications

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“…In particular, the introduction of inclisiran, bempedoic acid, and evinacumab for familial hypercholesterolemia has diversified therapeutic options, allowing for a more personalized approach. Today, clinicians have a spectrum of therapeutic choices to tailor interventions and achieve LDL-C target levels, taking part in the current orientation of a personalized secondary prevention therapy according to the residual cardiovascular risk [ 91 , 92 , 93 ]. Moreover, the promising results from various drugs currently in development hold the potential to further enhance clinical practice, overcoming some limitations of existing therapies.…”

Section: Discussionmentioning

confidence: 99%

Novel and Emerging LDL-C Lowering Strategies: A New Era of Dyslipidemia Management

Agnello,

Ingala,

Laterra

et al. 2024

JCM

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Atherosclerotic cardiovascular disease (ASCVD) represents a major global health challenge, significantly contributing to mortality rates. This chronic inflammatory condition affecting blood vessels is intricately linked to hypercholesterolemia, with elevated levels of low-density lipoprotein cholesterol (LDL-C) recognized as a central and modifiable risk factor. The effectiveness of lipid-lowering therapy (LLT) in mitigating ASCVD risk is well established, with studies revealing a substantial reduction in major ischemic events correlating with LDL-C reduction. While statins, often combined with ezetimibe, remain fundamental in dyslipidemia management, a significant proportion of patients on statin therapy continue to experience cardiovascular events. Recent pharmacological advancements, driven by a deeper understanding of atherogenesis, have unveiled novel therapeutic targets and potent drugs. Notably, agents like bempedoic acid and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors (evolocumab, alirocumab, inclisiran) have emerged as effective options to intensify LLT and achieve LDL-C goals, addressing limitations associated with statins, such as myopathy. Molecular insights into alternative pathways have spurred the investigation of emerging agents, offering promising perspectives for novel medications with efficacy comparable to established treatments, associated with advantages in cost and administration. This review provides a comprehensive overview of the evolving landscape of lipid-lowering strategies, highlighting the progress made in addressing ASCVD risk and the potential of upcoming therapies to further optimize cardiovascular prevention.

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Section: Discussionmentioning

confidence: 99%

Novel and Emerging LDL-C Lowering Strategies: A New Era of Dyslipidemia Management

Agnello,

Ingala,

Laterra

et al. 2024

JCM

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“…As a result, the concept of stable CAD has been reevaluated and the notion of residual CV risk has been introduced. This risk persists despite the use of the best available evidence-based secondary prevention strategies [ 133 ]. To significantly reduce this risk, comprehensive strategies should be employed, including: (a) a selection of the most appropriate diagnostic tools; (b) a personalized assessment of residual risk, taking into account contemporary, non-traditional risk factors and their evolution over time; (c) tailoring of therapeutic approaches, both pharmacological and non-pharmacological, to individual risk profiles; (d) an establishment of optimal and individualized follow-up protocols according to the CCS categories and their risk level; (e) implementing a multidisciplinary patient-centered approach to care that can incorporate innovative telemedicine and telemonitoring technologies; (f) promoting integrated management between hospital and community care; (g) incorporating non-pharmacological interventions to improve CV health education.…”

Section: Discussionmentioning

confidence: 99%

Management of Residual Risk in Chronic Coronary Syndromes. Clinical Pathways for a Quality-Based Secondary Prevention

Giubilato,

Lucà,

Abrignani

et al. 2023

JCM

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Chronic coronary syndrome (CCS), which encompasses a broad spectrum of clinical presentations of coronary artery disease (CAD), is the leading cause of morbidity and mortality worldwide. Recent guidelines for the management of CCS emphasize the dynamic nature of the CAD process, replacing the term “stable” with “chronic”, as this disease is never truly “stable”. Despite significant advances in the treatment of CAD, patients with CCS remain at an elevated risk of major cardiovascular events (MACE) due to the so-called residual cardiovascular risk. Several pathogenetic pathways (thrombotic, inflammatory, metabolic, and procedural) may distinctly contribute to the residual risk in individual patients and represent a potential target for newer preventive treatments. Identifying the level and type of residual cardiovascular risk is essential for selecting the most appropriate diagnostic tests and follow-up procedures. In addition, new management strategies and healthcare models could further support available treatments and lead to important prognostic benefits. This review aims to provide an overview of the diagnostic and therapeutic challenges in the management of patients with CCS and to promote more effective multidisciplinary care.

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“…Beyond lifestyle modifications, like quitting smoking, engaging in regular physical activity, and achieving weight loss, a range of pharmaceutical treatments, including lipid-level-lowering drugs, antiplatelet agents, GLP-1 analogues, and rivaroxaban, can substantially enhance the overall clinical trajectory of the disease [5]. The efficacy of the currently utilized or investigated drugs for managing PAD hinges on their ability to counteract the pathological mechanisms associated with atherosclerosis factors, such as diabetes, dyslipidemia, and arterial hypertension, as well as the underlying mechanisms of the so-called "residual risk" [6]. Despite receiving optimal medical treatments, individuals with similar risk profiles may experience diverse outcomes, progressing toward CLTI in distinct ways [7].…”

mentioning

confidence: 99%

The Challenges in Managing Peripheral Arterial Disease Complications

Biscetti,

Flex

2023

Hearts

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Residual cardiovascular risk, use of standard care treatments, and achievement of treatment goals in patients with cardiovascular disease

Cited by 4 publications

References 38 publications

Novel and Emerging LDL-C Lowering Strategies: A New Era of Dyslipidemia Management

Novel and Emerging LDL-C Lowering Strategies: A New Era of Dyslipidemia Management

Management of Residual Risk in Chronic Coronary Syndromes. Clinical Pathways for a Quality-Based Secondary Prevention

The Challenges in Managing Peripheral Arterial Disease Complications

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