Despite the routine use of cholesterol and blood pressure lowering therapy, anticoagulants, and heart failure drugs, many patients with cardiovascular disease remain at high risk of recurrent cardiovascular events. This is called residual risk.

This paper identifies several risk factors that contribute to this residual risk. Patients with low-grade inflammation, as measured by high blood levels of C-reactive protein (CRP), have been shown to have a 1.5- to 2.5-fold increased risk of recurrent cardiovascular events. . It has also been shown that patients with metabolic syndrome, a collection of obesity-related blood and fat tissue disorders, have a 32% increased risk of heart failure. Additionally, this paper shows how predictive models can be used to predict residual risk and treatment efficacy for individual patients. The LIFE-HF model was developed and shown how this model can be used to accurately predict life expectancy and lifetime benefit from medication for individual patients with heart failure. Existing predictive models were used to estimate the effects of colchicine (an anti-inflammatory drug) and icosapent ethyl (a lipid-lowering drug) on ​​individual patients. This showed that in 68-70% of patients, colchicine would be expected to reduce residual risk more effectively than intensifying cholesterol- or blood-pressure-lowering therapy. Icosapent ethyl reduces residual risk by 22-38%, depending on the patient’s residual risk at the start of treatment.

Finally, the results of all relevant studies of cholesterol-lowering therapy, taken together, show that the effects of cholesterol-lowering are stable over time in patients who already have cardiovascular disease, but they are at increased risk of developing cardiovascular disease. of patients showed a decline with age. Cardiovascular disease in the future.