Adjunctive pharmacological strategies for residual risk reduction after myocardial revascularisation

Pharmacological treatment remains vital in the effective management of atherosclerotic cardiovascular disease (ASCVD). Low-density lipoprotein (LDL) cholesterol-lowering therapies, such as statins, have consistently demonstrated robust efficacy in the primary and secondary prevention of cardiovascular events. The introduction of ezetimibe, bempedoic acid, and proprotein convertase subtilisin/kexin type 9 inhibitors have further strengthened the effectiveness of LDL cholesterol management, particularly in patients who are statin intolerant or who remain at high risk despite maximal tolerated statin therapy. In addition to managing LDL cholesterol, addressing residual lipid risk by targeting elevated triglyceride and lipoprotein(a) levels and low high-density lipoprotein cholesterol levels has emerged as a potentially important therapeutic consideration, as these are increasingly recognised as independent cardiovascular risk factors. Concurrently, inflammation is increasingly acknowledged as a significant contributor to atherogenesis and subsequent cardiovascular events. Clinical trials examining anti-inflammatory therapies, such as colchicine and interleukin-1β inhibitors (e.g., canakinumab), have demonstrated beneficial effects in reducing cardiovascular events independent of lipid modification. This narrative review provides an updated overview targeted specifically at physicians performing coronary artery bypass grafting or percutaneous coronary intervention. It summarises current evidence regarding established lipid-lowering therapies, emerging therapeutic approaches to address residual lipid risk, and the evolving role of anti-inflammatory interventions in the comprehensive management of ASCVD.