Cancro Francesco P, Bellino Michele, Silverio Angelo, Di Maio Marco, Esposito Luca, Palumbo Rossana, Manna Martina L, Formisano Ciro, Ferruzzi Germano, Vecchione Carmine, Galasso Gennaro
Department of Medicine Surgery and Dentistry, University of Salerno, Baronissi, SA, Italy.
Transl Med UniSa. 2024 Aug 28;26(2):99-110. doi: 10.37825/2239-9747.1058. eCollection 2024.
Despite the advancement in secondary cardiovascular prevention strategies for post-acute coronary syndrome (ACS) patients, the development of new drugs addressing dyslipidemia and the personalization of dual antiplatelet therapies (DAPT), these patients continue to suffer a significant incidence of recurrent ischemic events. Therefore, novel targets that can be tackled to reduce cardiovascular risk are needed to improve the outcome of this very high-risk population. The role of chronic inflammation and inflammasome in the development and progression of atherosclerosis has been broadly investigated in patients with established coronary artery disease (CAD) and recent randomized trials have highlighted the possibility to manage these targets with specific drugs such as colchicine and monocolonal antibodies with a significant improvement of cardiovascular outcomes in post-ACS patients. Lipoprotein(a) [Lp(a)] is the most promising non-traditional risk factor and has shown to predict worse outcome in post-ACS patients. Lowering Lp(a) through PCSK9 inhibitors and specific targeted therapies has shown positive results in reducing adverse cardiovascular events in patients with established CAD. The effect of microbiome and its alteration in gut dysbiosis seems to actively participate in residual cardiovascular risk of CAD patients; however, the risk-modifying effect of targeted-microbiome therapies hasn't been yet investigated in large population-based studies. Long-term outcome of post-ACS patients is a complex puzzle of multiple factors. In this minireview, we summarize the emerging risk factors that may interplay in the residual risk of post-ACS patients and their possible prognostic and therapeutic implications.
尽管针对急性冠状动脉综合征（ACS）后患者的二级心血管预防策略有所进展，针对血脂异常的新药不断研发以及双联抗血小板治疗（DAPT）实现了个体化，但这些患者仍有较高的复发性缺血事件发生率。因此，需要能够降低心血管风险的新靶点，以改善这一极高危人群的预后。慢性炎症和炎性小体在动脉粥样硬化发生发展中的作用已在确诊为冠状动脉疾病（CAD）的患者中得到广泛研究，最近的随机试验强调了使用秋水仙碱和单克隆抗体等特定药物来针对这些靶点进行治疗的可能性，这可显著改善ACS后患者的心血管预后。脂蛋白（a）[Lp（a）]是最具潜力的非传统危险因素，已被证明可预测ACS后患者的不良预后。通过前蛋白转化酶枯草溶菌素9（PCSK9）抑制剂和特定靶向治疗降低Lp（a）水平，已在确诊为CAD的患者中显示出降低不良心血管事件的积极效果。微生物群及其在肠道菌群失调中的改变似乎积极参与了CAD患者的残余心血管风险；然而，基于大规模人群的研究尚未对靶向微生物群治疗的风险修正作用进行调查。ACS后患者的长期预后是一个由多种因素构成的复杂难题。在这篇小型综述中，我们总结了可能在ACS后患者残余风险中相互作用的新兴危险因素及其可能的预后和治疗意义。
