Key result
Residual risk therapies including EPA and colchicine reduce cardiovascular events by up to ~41%.
Why the study?
The study was conducted to evaluate the efficacy and safety of drugs addressing residual cardiovascular risk across its lipid, inflammatory, and thrombotic components.
Do drugs targeting lipid, inflammatory, and thrombotic residual risk reduce atherosclerotic cardiovascular disease outcomes in patients with established risk?
Systematic Review
Do drugs targeting lipid, inflammatory, and thrombotic residual risk reduce atherosclerotic cardiovascular disease outcomes in patients with established risk?
Drugs targeting residual lipid, inflammatory, and thrombotic risk effectively reduce cardiovascular events with an acceptable safety profile, though combination antithrombotics increase bleeding risk.
Supports E-EPA or colchicine for residual ASCVD risk reduction; reinforces Level 1 evidence from 24 studies.
Background: The objective of this research is to evaluate the efficacy and safety of drugs in the residual risk in any of its three components: lipid, inflammatory and thrombotic risk. Methods: A systematic review was conducted of randomized clinical trials that included as a primary outcome, at least one of the conditions related to atherosclerotic cardiovascular disease. The databases used were PUBMED/MEDLINE, Scopus and ClinicalTrials.gov. The risk of bias of the studies was assessed using the Risk of Bias 2 tool. Results: and discussion: 18 studies were included in the analysis. Half of the studies had low risk of bias or some concerns. Several drugs were effective in reducing the primary outcome: ethyl eicosapentaenoeic acid (17.2 % E-EPA versus 22 % placebo HR: 0.75; 95 % CI 0.68-0.83; p < 0.001), colchicine in stable coronary artery disease (6.8 % vs placebo 9.6 %, HR 0.59, 95 % CI 0.57-0.83; p < 0.001), Canakinumab (150 mg vs placebo ARR 15 %, HR 0.85, 95 % CI 0.74-0.98; p = 0.021) and Rivaroxaban with Aspirin in stable atherosclerotic disease (4.1 % versus aspirin 5.4 %, HR 0.76, 95 % CI 0.66-0.86, P < 0.001). Serious adverse events did not differ between study groups, except for a higher rate of bleeding with the use of combination antithrombotic therapy. Conclusion: The residual risk can be reduced through the use of different drugs that act by modifying atherogenic lipid levels, modulating inflammatory pathways and the risk of thrombosis, with an acceptable safety profile in most studies.
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Hernandez-Sómerson et al. (2024) conducted a systematic review in Atherosclerotic cardiovascular disease. Drugs targeting residual lipid, inflammatory, and thrombotic risk vs. Placebo or standard therapy was evaluated on Conditions related to atherosclerotic cardiovascular disease. Drugs targeting residual risk effectively reduced cardiovascular outcomes, including ethyl eicosapentaenoic acid (HR 0.75; 95% CI 0.68-0.83) and colchicine (HR 0.59; 95% CI 0.57-0.83).
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