Reducing residual risk: modern pharmacochemistry meets old-fashioned lifestyle and adherence improvement

Area of Science:

• Cardiology
• Preventive Medicine
• Pharmacology

Background:

• Coronary heart disease management has advanced, yet cardiovascular (CV) risk and subclinical heart disease burdens remain high globally.
• Many patients fail to reach therapeutic goals, experience treatment intolerance, or lack adherence, while major CV events persist even with target attainment.
• Prevalence of risk factors like obesity and diabetes is increasing, particularly in children, with less than 1% of American adults and adolescents achieving ideal CV health.

Purpose of the Study:

• To highlight the persistent global burden of cardiovascular risk and subclinical heart disease.
• To underscore the limitations of current therapeutic approaches in achieving optimal patient outcomes.
• To emphasize the need for a multifaceted strategy to improve cardiovascular health and reduce residual risk.

Main Methods:

• Review of current challenges in cardiovascular disease management and risk factor prevalence.
• Analysis of the impact of non-adherence, treatment intolerance, and persistent risk factors.
• Discussion of emerging drug therapies and the necessity of integrated management strategies.

Main Results:

• Despite advances, a significant global burden of cardiovascular risk and subclinical disease persists.
• Current interventions are insufficient for many patients, with increasing prevalence of risk factors like obesity and diabetes.
• Novel drug therapies show promise but require integration with comprehensive management approaches.

Conclusions:

• Meaningful improvement in total and residual cardiovascular risk requires an optimal mix of all available modalities.
• This includes earlier and more effective prevention, aggressive medical care, revascularization, device implantation, and judicious use of novel agents.
• Environmental reengineering is also crucial for addressing the growing CV risk factor epidemic.