Figure 1
The pathways of residual cardiovascular risk, beyond traditional risk factors, with evidence-based therapeutic options. Reprinted with permission.32 COLCOT: Colchicine Cardiovascular Outcomes Trial; CANTOS: Canakinumab Anti-inflammatory Thrombosis Outcomes Study; JUPITER: Justification for the Use of Statins in Prevention: an Intervention Trial Evaluating Rosuvastatin; PEGASUS TIMI 54: Prevention of Cardiovascular Events in Patients with Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of Aspirin–Thrombolysis In Myocardial Infarction 54; THEMIS-PCI: The Effect of Ticagrelor on Health Outcomes in Diabetes Mellitus Patients Intervention Study-PCI; COMPASS: Cardiovascular Outcomes for People Using Anticoagulation Strategies; REDUCE-IT: Reduction of Cardiovascular Events With EPA–Intervention.
Table 1
Emerging targets and therapeutics to reduce ASCVD risk. Used and adapted with permission.36 ASCVD: atherosclerotic cardiovascular disease; GLP-1: glucagon-like peptide 1; LDL-C: low density lipoprotein-cholesterol; SGLT-2: sodium glucose cotransporter-2; siRNA: silencing ribonucleic acid; IL-1β: interleukin-1β.
| COMORBIDITY | TARGET | THERAPEUTIC |
|---|---|---|
| Dyslipidemia | LDL-C, triglycerides, lipoprotein(a) | Bempedoic acid, monoclonal antibodies (alirocumab, evolocumab, evinacumab), siRNA (inclisiran), icosapent ethyl, antisense oligonucleotides (APOCIII-LRx, IONIS-APO(a)-LRx) |
| Inflammation | IL-1β | Canakinumab, colchicine |
| Diabetes | SGLT-2, GLP-1 receptor | Canagliflozin, dapagliflozin, empagliflozin, abiglutide, dulaglutide, exenatide, liraglutide, lixisenatide, semaglutide, tirzepatide |
| Obesity | Appetite, stomach capacity | Orlistat, locaserin, naltrexone-bupropion, phentermine-topiramate, liraglutide, tirzepatide, gastric bypass, sleeve gastrectomy, adjustable gastric band, biliopancreatic diversion with duodenal switch |
| Hypertension | Vasopeptidase, aldosterone synthase, soluble epoxide hydrolase, natriuretic peptide A, vasoactive intestinal peptide receptor 2, catheter-based interventions | Vaccines against angiotensin II and its receptor type I, renal denervation, baroreflex activation therapy |
| Thrombosis | Factor Xa, P2Y12 receptor | Rivaroxaban, ticagrelor |
Table 2
Common referrals to a preventive cardiology center. ASCVD: atherosclerotic cardiovascular disease.
| Personal or family history of ASCVD |
| ASCVD with recurrent events |
| Severe or difficult lipid disorders |
| Inherited lipid disorders (particularly children) |
| Genetic testing |
| Risk assessment with advanced lipid testing/novel biomarkers |
| Noninvasive atherosclerosis imaging to refine risk estimation |
| Statin-associated side effects |
| Lifestyle counseling (weight management, smoking cessation, diet, etc) |
| Healthy individuals interested in understanding and lowering ASCVD risk |
| Review and/or consultation for preventive medical therapies |
| Participation in clinical trials of novel preventive therapies |