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Optical coherence tomography is a kid on the block: I would choose intravascular ultrasound A systematic review of factors predicting door to balloon time in ST-segment elevation myocardial infarction treated with percutaneous intervention Biological Phenotypes of Heart Failure With Preserved Ejection Fraction Correlation and prognostic role of neutrophil to lymphocyte ratio and SYNTAX score in patients with acute myocardial infarction treated with percutaneous coronary intervention: A six-year experience Outcomes in Patients Treated With Thin-Strut, Very Thin-Strut, or Ultrathin-Strut Drug-Eluting Stents in Small Coronary Vessels: A Prespecified Analysis of the Randomized BIO-RESORT Trial Pharmacoinvasive and Primary Percutaneous Coronary Intervention Strategies in ST-Elevation Myocardial Infarction (from the Mayo Clinic STEMI Network) Symptom onset-to-balloon time and mortality in the first seven years after STEMI treated with primary percutaneous coronary intervention Oxygen Therapy in Suspected Acute Myocardial Infarction Lower Risk of Heart Failure and Death in Patients Initiated on SGLT-2 Inhibitors Versus Other Glucose-Lowering Drugs: The CVD-REAL Study Bleeding-Related Deaths in Relation to the Duration of Dual-Antiplatelet Therapy After Coronary Stenting

Original Research2018 Jun 12;137(24):2551-2553.

JOURNAL: Article Link

Conceptual Framework for Addressing Residual Atherosclerotic Cardiovascular Disease Risk in the Era of Precision Medicine

Patel KV, Pandey A, de Lemos JA et al. Keywords: atherosclerosis; biomarkers; precision medicine; residual risk; secondary prevention

ABSTRACT

Until recently, therapies to mitigate atherosclerotic cardiovascular disease (ASCVD) risk have been limited to lifestyle interventions, blood pressure-lowering medications, high-intensity statin therapy, antiplatelet agents, and, in select patients, coronary artery revascularization. Despite administration of these evidence-based therapies, substantial residual risk for cardiovascular events persists, particularly among individuals with known ASCVD. Moreover, the current guideline-based approach does not adequately account for patient-specific, causal pathways that lead to ASCVD progression and complications. In the past few years, multiple new pharmacological agents, targeting conceptually distinct pathophysiological targets, have been shown in large and well-conducted clinical trials to lower cardiovascular risk among patients with established ASCVD receiving guideline-directed medical care. These evidenced-based therapies reduce event rates and, in some cases, all-cause and cardiovascular mortality; these benefits confirm important new disease targets and challenge the adequacy of the current standard of care for secondary prevention.

After years of treating our patients after an acute coronary syndrome event with the same core group of medications that have been proven to be safe, beneficial, and cost-effective, a diverse array of potentially beneficial options to address residual risk is now available. The near simultaneous development of these new approaches to secondary prevention disrupts existing paradigms regarding assessment and treatment of residual risk. For example, consider a hypothetical patient with obesity, hypertension, type 2 diabetes mellitus, and hyperlipidemia who had a non-ST elevation myocardial infarction and received an intracoronary drug-eluting stent. This patient would likely be …

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