Beyond therapeutic maximalism: Prioritization and personalization in preventive therapies

Area of Science:

• Cardiovascular Medicine
• Pharmacology
• Lipidology

Background:

• Lipid management has evolved from statin monotherapy to a complex, multi-axis approach.
• New therapies target low-density lipoprotein cholesterol, triglyceride-rich lipoproteins, lipoprotein(a), and vascular inflammation.
• Emerging agents include PCSK9 inhibitors, CETP inhibitors, and Lp(a)-directed therapies.

Purpose of the Study:

• To address the increasing complexity and challenges of multidrug lipid management.
• To propose a framework for optimizing cardiovascular protection in high-risk patients.
• To ensure sustainable, patient-centered lipid management strategies.

Main Methods:

• Review of current lipid management paradigms and emerging therapies.
• Analysis of treatment complexity, healthcare burden, and adherence challenges.
• Development of a Clinical Prioritization and Personalization Framework.

Main Results:

• Current lipid management involves multiple drug classes targeting diverse pathways.
• Multidrug regimens increase complexity, burden, and adherence challenges.
• Long-term effectiveness depends on adherence, affordability, and feasibility.

Conclusions:

• A shift towards individualized, risk-based intensification is necessary.
• Comprehensive residual risk management is crucial for cardiovascular protection.
• Optimizing treatment delivery is key to sustainable, patient-centered care.