Abstract
Following an acute coronary syndrome (ACS), heightened predisposition to atherothrombotic events may persist for years. Advances in understanding the pathobiology that underlies this elevated risk furnish a mechanistic basis for devising long-term secondary prevention strategies. Recent progress in ACS pathophysiology has challenged the focus on single “vulnerable plaques” and shifted toward a more holistic consideration of the “vulnerable patient,” thus highlighting the primacy of medical therapy in secondary prevention. Despite current guideline-directed medical therapy, a consistent proportion of post-ACS patients experience recurrent atherothrombosis due to unaddressed “residual risk”: contemporary clinical trials underline the pivotal role of platelets, coagulation, cholesterol, and systemic inflammation and provide a perspective on a personalized, targeted approach. Emerging data sheds new light on heretofore unrecognized residual risk factors. This review aims to summarize evolving evidence relative to secondary prevention of atherothrombosis, with a focus on recent advances that promise to transform the management of the post-ACS patient.
Original language | English (US) |
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Pages (from-to) | 2886-2903 |
Number of pages | 18 |
Journal | Journal of the American College of Cardiology |
Volume | 72 |
Issue number | 23 |
DOIs | |
State | Published - Dec 11 2018 |
Keywords
- atherosclerosis
- cholesterol
- inflammation
- post-MI stable coronary artery disease
- residual risk
- thrombosis
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine