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Intermediate and long-term residual cardiovascular risk in patients with established cardiovascular disease treated
K Vijayaraghavan1, S Baum2,3, N R Desai4
1Division of Cardiology, University of Arizona College of Medicine, Phoenix, AZ, United States.
Insights
Despite statin therapy, cardiovascular events remain common in patients with established cardiovascular disease. Additional treatments, like eicosapentaenoic acid, are crucial for reducing residual cardiovascular risk.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Statins are first-line for secondary prevention of cardiovascular (CV) events, targeting low-density lipoprotein cholesterol (LDL-C).
- Residual CV risk persists even with well-controlled LDL-C levels in patients on statins.
Purpose of the Study:
- To review contemporary literature on intermediate- and long-term event rates in patients with established CV disease treated with statins.
- To highlight the need for additional therapies beyond statins to manage persistent CV risk.
Main Methods:
- Narrative review of existing studies.
- Analysis of event rates in patients with established CV disease (coronary artery disease, cerebrovascular disease, peripheral arterial disease) on statin therapy.
Main Results:
- Cumulative CV event incidence can reach approximately 40% over 10 years in patients on statins.
- High rates of recurrent stroke (up to 19% at 7 years) and repeat revascularization or CV death in peripheral artery disease (up to 38% and 33% at 3 years, respectively) are observed.
Conclusions:
- Additional treatment strategies are necessary to mitigate persistent CV risk in patients with established CV disease receiving statin therapy.
- Agents like eicosapentaenoic acid, targeting pathways beyond LDL-C, show promise for further risk reduction.
Introduction:
Statins remain the first-line treatment for secondary prevention of cardiovascular (CV) events, with lowering of low-density lipoprotein cholesterol (LDL-C) being their therapeutic target. Although LDL-C reduction significantly lowers CV risk, residual risk persists, even in patients with well-controlled LDL-C; thus, statin add-on agents that target pathways other than LDL-C, such as the omega-3 fatty acid eicosapentaenoic acid, may help to further reduce persistent CV risk in patients with established CV disease.
Methods:
This narrative review examines the contemporary literature assessing intermediate- and long-term event rates in patients with established CV disease treated with statins.
Results:
CV event rates among patients treated with statins who have established CV disease, including coronary artery disease, cerebrovascular disease, or peripheral arterial disease, accumulate over time, with a cumulative incidence of CV events reaching up to approximately 40% over 10 years. Recurrent stroke occurs in up to 19% of patients seven years after a first cerebrovascular event. Repeat revascularization and CV-related death occurs in up to 38% and 33% of patients with peripheral artery disease after three years, respectively.
Discussion:
Additional treatment strategies, such as eicosapentaenoic acid, are needed to reduce persistent CV risk in patients with established CV disease treated with statins.
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