Author + information
- Received July 8, 2018
- Revision received August 21, 2018
- Accepted September 4, 2018
- Published online December 3, 2018.
- Guglielmo Gallone, MDa,b,
- Luca Baldetti, MDa,
- Matteo Pagnesi, MDa,
- Azeem Latib, MDc@azeemlatib,
- Antonio Colombo, MDd,∗ (, )@SanRaffaeleMI@BrighamWomens,
- Peter Libby, MDe and
- Francesco Giannini, MDd
- aUnit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy
- bDivision of Cardiology, Department of Medical Sciences, Città della Scienza e della Salute Hospital, University of Turin, Turin, Italy
- cDepartment of Cardiology, Montefiore Medical Center, New York, New York
- dInterventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
- eDivision of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
- ↵∗Address for correspondence:
Dr. Antonio Colombo, Interventional Cardiovascular Unit, Villa Maria Cecilia Hospital, Via Corriera 1, 48010 Cotignola, Italy.
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.
Dr. Libby has served as an unpaid consultant for Amgen, AstraZeneca, Esperion Therapeutics, Ionis Pharmaceuticals, Sanofi-Regeneron, and XBiotech, Inc.; has served on the scientific advisory board of Corvidia Therapeutics, Olatec Therapeutics, and Medimmune; and has received laboratory funding from Novartis. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received July 8, 2018.
- Revision received August 21, 2018.
- Accepted September 4, 2018.
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