New Enemies of the Arteries: Residual Risk and Cardiovascular Disease
Cardiologists around the world are concerned about a phenomenon known as “residual risk,” which poses a significant challenge in preventing cardiovascular events such as heart attacks and strokes. Despite efforts to control traditional risk factors such as hypertension, high cholesterol, diabetes, and cigarette smoking, many individuals still experience these life-threatening incidents. On the occasion of World Day of the heart, Professor Filippo Crea, a renowned Cardiology expert, sheds light on these new enemies of the arteries and explores possible strategies to counteract them.
Residual risk refers to the failure to completely prevent cardiovascular events, even when traditional risk factors are managed effectively. Lowering blood pressure, reducing cholesterol and blood sugar levels, and quitting smoking are crucial steps in prevention. However, residual risk remains a significant concern. Professor Crea emphasizes the need to do more and better to tackle this persistent risk.
In terms of prevention, combating traditional risk factors remains the primary focus. Targeting arterial hypertension, dyslipidemia, diabetes, smoking, and obesity is of utmost importance. However, even when these factors are normalized, a considerable portion of risk, referred to as residual risk, remains. This residual risk is associated with four “new” risk factors: lipoprotein(a) and triglycerides, inflammation, thrombosis, and air pollution.
Lipoprotein(a) and triglycerides, powerful risk factors independent of bad cholesterol (LDL), have often been overlooked due to the lack of appropriate therapies. Thanks to advancements in RNA technology, new drugs have emerged to combat these lipids, representing a crucial objective in prevention 3.0. Similarly, protecting against thrombotic disease, which contributes to heart attacks and sudden death, can be enhanced with novel antiplatelet and anticoagulant drugs.
Inflammation, largely driven by environmental risk factors and an unhealthy lifestyle, is another significant contributor to the risk of heart attacks. The C-reactive protein (CRP) serves as a marker for this inflammatory risk. Even when inflammation resulting from an incorrect lifestyle is corrected, a portion of inflammatory risk persists and may require appropriate medications. Recent studies have shown promising results with the use of colchicine, an old drug primarily utilized for gout and pericarditis, in secondary prevention of heart attacks.
Additionally, the so-called residual environmental risk, particularly prevalent in urban areas with high air pollution, must be addressed. This risk deeply affects the mechanisms leading to atherosclerotic disease, heart attacks, and strokes. While pharmacological therapies have limited effectiveness in combating environmental risk, impactful political choices to reduce pollution levels can make a significant difference.
Cardiovascular disease prevention efforts have come a long way in addressing traditional risk factors. However, the battle against residual risk requires a comprehensive approach. Tackling lipids, inflammation, thrombosis, and environmental factors demands advancements in drug therapies, lifestyle modifications, and substantial policy changes. By targeting these new enemies of the arteries, cardiologists hope to make further strides in preventing cardiovascular events and safeguarding heart health for all individuals.