Optimal Medical Therapy Targeting Lipids and Inflammation for Secondary Prevention in Patients Undergoing Percutaneous Coronary Intervention
Imma Forzano, Domenico Florimonte, Viviana Narciso, Mario Enrico Canonico, Domenico Simone Castiello, Lina Manzi, Stefano Cristiano, Alessandra Spinelli, Donato Maria Vallone, Dario D’Alconzo, Federica Semplice, Roberta Paolillo, Giuseppe Giugliano, Arturo Cesaro, Felice Gragnano, Paolo Calabrò, Giovanni Esposito, Giuseppe Gargiulo
Abstract
Cardiovascular diseases (CVDs), including coronary artery disease (CAD), are the main causes of mortality and morbidity worldwide. The pathophysiology of CAD includes atherosclerosis, a chronic process leading to atherosclerotic plaque development. Clinical manifestations could be chronic, such as in the chronic coronary syndrome (CCS) scenario, or acute, such as acute coronary syndrome (ACS). The risk of subsequent cardiovascular (CV) events depends on the risk category defined by international guidelines. In particular, patients who have experienced a CV event requiring percutaneous coronary intervention (PCI) remain at heightened residual risk for subsequent events, despite advancements in standard-of-care strategies. Therefore, comprehensive residual risk management is essential in this population to mitigate ischemic risk. Secondary prevention includes different targets of treatments-hypertension, dyslipidemia, diabetes mellitus, body weight control, smoking habit reduction, and healthy lifestyle promotion. Nevertheless, there is a critical, unmet need for therapeutic strategies for this high-risk population. Growing evidence shows that atherogenic lipids and vascular inflammation drive residual risk after PCI, despite guideline-directed therapy. This review summarizes more recent evidence about secondary prevention focusing on optimal medical therapy (OMT), targeting lipids and inflammation for patients undergoing PCI.