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Drug intervention as an emerging concept for secondary prevention in patients with coronary disease

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Abstract

Non-culprit lesion-related coronary events are a significant concern in patients with coronary artery disease (CAD) undergoing coronary intervention. Since several studies using intra-coronary imaging modalities have reported a high prevalence of vulnerable plaques in non-culprit lesions at the initial coronary event, the immediate stabilization of these plaques by intensive pharmacological regimens may contribute to the reduction in the adverse events. Although current treatment guidelines recommend the titration of statin and other drugs to attain the treatment goal of low-density lipoprotein cholesterol (LDL-C) level in patients with CAD, the early prescription of strong LDL-C lowering drugs with more intensive regimen may further reduce the incidence of recurrent cardiovascular events. In fact, several studies with intensive regimen have demonstrated a higher percentage of patients with the attainment of LDL-C treatment goal in the early phase following discharge. In addition to many imaging studies showing plaque stabilization by LDL-C lowering drugs, several recent reports have shown the efficacy of early statin and proprotein convertase subtilisin/kexin type 9 inhibitors on the immediate stabilization of non-culprit coronary plaques. To raise awareness regarding this important concept of immediate plaque stabilization and subsequent reduction in the incidence of recurrent coronary events, the term ‘Drug Intervention’ has been introduced and gradually applied in the clinical field, although a clear definition is lacking. The main target of this concept is patients with acute coronary syndrome as a higher prevalence of vulnerable plaques in non-culprit lesions in addition to the worse clinical outcomes has been reported in recent imaging studies. In this article, we discuss the backgrounds and the concept of drug intervention.

Graphical Abstract

Concept of drug intervention in patients with coronary artery disease. ACS acute coronary syndrome, ASAP as soon as possible, LDL-C low-density lipoprotein cholesterol, PCSK9 proprotein convertase subtilisin/kexin type 9, TCFA thin-cap fibroatheroma

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Acknowledgements

Dr. Minami, Dr. Ako, Dr. Ikari and Dr. Morino has received remuneration for lecture from Amgen K.K., Novartis Pharma K.K. Dr. Tsujita has received remuneration for lecture from Amgen K.K., Novartis Pharma K.K., Bayer Yakuhin, Ltd., Kowa Pharmaceutical Co. Ltd., and received trust research/joint research funds from Bayer Yakuhin, Ltd., Mochida Pharmaceutical Co. Ltd., EA Pharma Co. Ltd. Dr. Yokoi has received remuneration for lecture from Amgen K.K. Dr. Kozuma has received remuneration for lecture from Amgen K.K., Novartis Pharma K.K., Bayer Yakuhin, Ltd., Mochida Pharmaceutical Co. Ltd. Dr. Kobayashi has received remuneration for lecture from Daiichi Sankyo Co. Ltd., Abbott Medical Co. Ltd., and received research funds from Otsuka Pharmaceutical Co. Ltd., Nippon Boehringer Ingelheim Co., Ltd., NIPRO CORPORATION, Japan Lifeline Co. Ltd., Abbott Medical Co. Ltd.

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Authors and Affiliations

  1. Department of Cardiovascular Medicine, Kitasato University Hospital, 1-15-1 Kitasato, Minami-Ku, Sagamihara, 252-0375, Japan

    Yoshiyasu Minami & Junya Ako

  2. Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan

    Kenichi Tsujita

  3. Department of Cardiology, Fukuoka Sanno Hospital, Fukuoka, Japan

    Hiroyoshi Yokoi

  4. Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine, Isehara, Japan

    Yuji Ikari

  5. Division of Cardiology, Department of Internal Medicine, Iwate Medical University, Yahaba-Cho, Japan

    Yoshihiro Morino

  6. Department of Cardiovascular Medicine, Chiba University, Chiba, Japan

    Yoshio Kobayashi

  7. Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan

    Ken Kozuma

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  1. Yoshiyasu Minami
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Minami, Y., Ako, J., Tsujita, K. et al. Drug intervention as an emerging concept for secondary prevention in patients with coronary disease. Cardiovasc Interv and Ther (2024). https://doi.org/10.1007/s12928-024-00994-7

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