High residual cardiovascular risk after lipid-lowering: prime time for Predictive, Preventive, Personalized, Participatory, and Psycho-cognitive medicine

Abstract

As time has come to translate trial results into individualized medical diagnosis and therapy, we analyzed how to minimize residual risk of cardiovascular disease (CVD) by reviewing papers on “residual cardiovascular disease risk”. During this review process we found 989 papers that started off with residual CVD risk after initiating statin therapy, continued with papers on residual CVD risk after initiating therapy to increase high-density lipoprotein-cholesterol (HDL-C), followed by papers on residual CVD risk after initiating therapy to decrease triglyceride (TG) levels. Later on, papers dealing with elevated levels of lipoprotein remnants and lipoprotein(a) [Lp(a)] reported new risk factors of residual CVD risk. And as new risk factors are being discovered and new therapies are being tested, residual CVD risk will be reduced further. As we move from CVD risk reduction to improvement of patient management, a paradigm shift from a reductionistic approach towards a holistic approach is required. To that purpose, a personalized treatment dependent on the individual’s CVD risk factors including lipid profile abnormalities should be configured, along the line of P5 medicine for each individual patient, i.e., with Predictive, Preventive, Personalized, Participatory, and Psycho-cognitive approaches.

Bibliometric analysis of residual cardiovascular risk: trends and frontiers

“…Our research corroborates the significance of comprehensive lipid reduction in lowering the risk of cardiovascular events, echoing the findings of several recent studies that underscore the critical role of comprehensive lipid management in reducing residual cardiovascular risk [ 12 , 121 , 122 ]. With the advent of PCSK9 inhibitors and siRNA therapeutics, we have not only witnessed a diversification of treatment modalities but also observed how these novel therapies challenge and complement current treatment guidelines.…”

“…Internists, nutritionists, rehabilitation therapists, and other experts must collaborate to provide comprehensive care for patients. With the advancement of digital medical technology, telemedicine, wearable devices, health apps, and other tools are becoming increasingly significant in the management of CVD [ 12 ]. These technologies not only allow doctors to assess and monitor patients' health status more conveniently but also empower patients to take a more active role in managing their health, thereby further diminishing residual cardiovascular risk.…”

The effect of lipid-lowering therapy on lipid-related residual risk factors: a prospective study

“…In the current era, the expansion of non-statin alternatives, including PCSK9 inhibitors, bempedoic acid, and inclisiran, offers enhanced strategies for the improved management of vulnerable patients [ 51 , 52 ]. This finding underscores the complexity of lipid management in CVD and highlights the necessity for targeted interventions and personalized treatment based on the patient’s specific CVD risk factors [ 53 ].…”

Omega-3 (n-3) Fatty Acid–Statin Interaction: Evidence for a Novel Therapeutic Strategy for Atherosclerotic Cardiovascular Disease

“…Management of ASCVD remains a challenge despite effective lipid-lowering treatments, as specified in current guidelines, since a residual cardiovascular risk persists [124]. While statins and n-3 PUFAs offer synergistic effects on dyslipidemia, the pleiotropic effects of the two overlap, including modulation of inflammatory markers and immune cell function, stabilization of atherosclerotic plaques, and improvement of endothelial function [19].…”