Medical Therapy for Long-Term Prevention of Atherothrombosis Following an Acute Coronary Syndrome: JACC State-of-the-Art Review

Guglielmo Gallone, Luca Baldetti, Matteo Pagnesi, Azeem Latib, Antonio Colombo, Peter Libby, Francesco Giannini

Research output: Contribution to journalReview articlepeer-review

25 Scopus citations

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 languageEnglish (US)
Pages (from-to)2886-2903
Number of pages18
JournalJournal of the American College of Cardiology
Volume72
Issue number23
DOIs
StatePublished - Dec 11 2018
Externally publishedYes

Keywords

  • atherosclerosis
  • cholesterol
  • inflammation
  • post-MI stable coronary artery disease
  • residual risk
  • thrombosis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Fingerprint

Dive into the research topics of 'Medical Therapy for Long-Term Prevention of Atherothrombosis Following an Acute Coronary Syndrome: JACC State-of-the-Art Review'. Together they form a unique fingerprint.

Cite this