Adjunctive pharmacological strategies for residual risk reduction after myocardial revascularisation.

Asahi Oshima, Patrick W Serruys, Scot Garg, J William McEvoy, David A Wood, Torsten Doenst, David P Taggart, John D Puskas, Ajmal Shajahan, Faisal Sharif, Kotaro Miyashita, Akihiro Tobe, Tsung-Ying Tsai, Pruthvi C Revaiah, Fidelma Dunne, Roxana Mehran, Matthew J Budoff, John J Kastelein, Eric S G Stroes, Ramzi Khamis, Wolfgang Koenig, Yoshinobu Onuma

Journal: EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology 2026;22(4):202-223

PMID: 41697657

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Abstract

Pharmacological treatment remains vital in the effective management of atherosclerotic cardiovascular disease (ASCVD). Low-density lipoprotein (LDL) cholesterol-lowering therapies, such as statins, have consistently demonstrated robust efficacy in the primary and secondary prevention of cardiovascular events. The introduction of ezetimibe, bempedoic acid, and proprotein convertase subtilisin/kexin type 9 inhibitors have further strengthened the effectiveness of LDL cholesterol management, particularly in patients who are statin intolerant or who remain at high risk despite maximal tolerated statin therapy. In addition to managing LDL cholesterol, addressing residual lipid risk by targeting elevated triglyceride and lipoprotein(a) levels and low high-density lipoprotein cholesterol levels has emerged as a potentially important therapeutic consideration, as these are increasingly recognised as independent cardiovascular risk factors. Concurrently, inflammation is increasingly acknowledged as a significant contributor to atherogenesis and subsequent cardiovascular events. Clinical trials examining anti-inflammatory therapies, such as colchicine and interleukin-1β inhibitors (e.g., canakinumab), have demonstrated beneficial effects in reducing cardiovascular events independent of lipid modification. This narrative review provides an updated overview targeted specifically at physicians performing coronary artery bypass grafting or percutaneous coronary intervention. It summarises current evidence regarding established lipid-lowering therapies, emerging therapeutic approaches to address residual lipid risk, and the evolving role of anti-inflammatory interventions in the comprehensive management of ASCVD.

Address: CORRIB Research Centre for Advanced Imaging and Core Laboratory, University of Galway, Galway, Ireland.; Department of Cardiology, School of Medicine, University of Galway, Galway, Ireland and Cardiology Department, Galway University Hospital, Galway, Ireland.; Department of Cardiology, Royal Blackburn Hospital, Blackburn, United Kingdom.; School of Medicine, University of Central Lancashire, Preston, United Kingdom.; Division of Cardiology and National Institute for Prevention and Cardiovascular Health, National University of Ireland, Galway, Ireland.; Preventive Cardiology at the National Institute of Prevention and Cardiovascular Health (NIPC), University of Galway, Galway, Ireland.; Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich Schiller University of Jena, Jena, Germany.; Nuffield Department of Surgical Sciences, John Radcliffe Hospital, Oxford University, Oxford, United Kingdom.; Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, USA.; CORRIB Research Centre for Advanced Imaging and Core Laboratory, University of Galway, Galway, Ireland.; Department of Cardiology, Saolta Group, Galway University Hospital Health Service Executive, Galway, Ireland and University of Galway, Galway, Ireland.; Institute for Clinical Trial, Clinical Science Institute, University of Galway, Galway, Ireland.; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.; Division of Cardiology, Harbor-UCLA Medical Center, The Lundquist Institute, Los Angeles, CA, USA.; NewAmsterdam Pharma B.V, Naarden, the Netherlands.; Department of Vascular Medicine, Academic Medical Center, Amsterdam, the Netherlands.; Imperial College London National Heart and Lung Institute, Vascular Science, London, United Kingdom.; Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.; German Centre for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Munich, Germany.; Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany.

DOI: 10.4244/EIJ-D-25-00598

MeSH Terms: Humans, Myocardial Revascularization, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Cholesterol, LDL, Anticholesteremic Agents, Anti-Inflammatory Agents