What does vascular protection mean for patients with coronary artery disease?

Patients with coronary artery disease (CAD) are at high risk of potentially fatal ischaemic events, such as myocardial infarction (MI) and stroke. While this risk is highest in the first 6–12 months after an acute coronary event, 1 during which guidelines recommend more aggressive antithrombotic therapies, 2,3 patients remain at risk long after the first year.4 In the recent PEGASUS-TIMI 54 trial, which enrolled patients 1–3 years after an MI, 9% of patients on standard therapy experienced a major cardiovascular (CV) event over the 3-year follow-up period.5 Even patients who received a more aggressive antiplatelet strategy (ticagrelor 60 mg bid plus acetylsalicylic acid [ASA]) had an 8% residual risk of major adverse CV events, highlighting the high risk in this population despite optimized antiplatelet therapy.

These data are supported by real-world data from the multinational REACH registry, which included 40,258 patients with documented CAD. Despite the majority of patients receiving guideline-recommended secondary prevention strategies,6 approximately 5% and 12% of patients with CAD experienced a major CV event at 1 year and 3 years follow-up, respectively.7

Together, these data from clinical trials and routine clinical practice demonstrate the high residual risk of major CV events in patients with CAD, despite guideline-recommended therapies. To address this, it is essential that patients receive a comprehensive long-term vascular protection strategy to manage all aspects of their condition. Several recent clinical trials have led to the approval of agents for improved long-term thrombosis prevention,5,8 lipid control9 and blood glucose management,10,11 and further trials in these areas are ongoing.


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