Jul 2026· Progress in cardiovascular diseases· 1 citation· 10 references
Medicine
TL;DR
A Clinical Prioritization and Personalization Framework centered on individualized risk-based intensification, comprehensive residual risk management, and optimization of treatment delivery is proposed to achieve sustainable, patient-centered cardiovascular protection.
Abstract
The landscape of lipid management has transitioned from a statin-monotherapy and statin-intensification paradigm to a sophisticated, multi-axis intervention model targeting low-density lipoprotein cholesterol, triglyceride-rich lipoproteins, lipoprotein(a), and vascular inflammation. The emergence of PCSK9-targeted small interfering RNA therapies, CETP inhibitors, and Lp(a)-directed antisense and RNA based agents has enabled complementary modulation of diverse lipid pathways through distinct molecular targets. However, this increasingly multidrug approach may also increase treatment complexity, healthcare burden, and adherence challenges, particularly among high-risk patients already receiving multidrug cardiometabolic therapy. Although intensive and sustained LDL-C lowering remains foundational to preventive cardiology, the real-world effectiveness of increasingly complex treatment strategies may ultimately depend on long-term adherence, affordability, patient capacity, and implementation feasibility. We propose a Clinical Prioritization and Personalization Framework centered on individualized risk-based intensification, comprehensive residual risk management, and optimization of treatment delivery to achieve sustainable, patient-centered cardiovascular protection.
These agents have expanded treatment options for patients with familial dyslipidaemia, severe hypertriglyceridaemia, and persistent residual cardiovascular risk while paving the way for precision medicine.
Aryan Arora· Beyond the Pill – The Future...· 0 citations
Cardiovascular diseases remain the leading cause of mortality worldwide despite
significant advances in preventive cardiology. Dyslipidemia is one of the most
important modifiable risk factors contributing to the development and progression of
atherosclerotic cardiovascular disease. While statins continue to represent the
cornerstone of lipid-lowering therapy, a substantial proportion of high-risk patients fail
to achieve recommended low-density lipoprotein cholesterol targets or experience
recurrent cardiovascular events despite optimal treatment. Recent years have witnessed
remarkable progress in the development of novel lipid-lowering agents that target
different pathways of lipoprotein metabolism, offering improved efficacy and longterm
cardiovascular protection.
Emerging therapeutic strategies include proprotein convertase subtilisin/kexin
type 9 (PCSK9) monoclonal antibodies, small interfering RNA (siRNA)-based
therapies such as inclisiran, adenosine triphosphate citrate lyase inhibitors represented
by bempedoic acid, and innovative approaches targeting lipoprotein(a), angiopoietinlike
protein 3, and apolipoprotein C-III. These therapies not only achieve profound
reductions in LDL-C but also address residual cardiovascular risk that persists despite
intensive statin therapy. Furthermore, advances in precision medicine, genetic
profiling, and artificial intelligence have facilitated individualized lipid management
strategies, improving patient adherence and optimizing clinical outcomes. This review
summarizes current evidence regarding novel lipid-lowering therapies, their
mechanisms of action, clinical efficacy, safety profiles, and future perspectives in the
prevention of cardiovascular diseases.
Galymzhan Qorazov, Ulykbek Daurenov, Aisulu Amirbai et al.· International Scientific Uni...· 0 citations
This expert position paper proposes practical algorithms for a precision medicine approach in Latin America, matching treatment intensity to individual risk profiles for the primary and secondary prevention of atherosclerotic cardiovascular disease.
C. Ponte-Negretti, A. Lorenzatti, F. Wyss-Quintana et al.· Frontiers in Medicine· 0 citations
Evidence suggests that genotype-guided therapy, PFT-guided treatment, and individualized DAPT duration may improve the balance between ischemic protection and bleeding risk in selected high-risk populations, but routine implementation remains limited by inconsistent clinical outcome benefits.
Sai Praneeth Chaparala, Abhishek Hanumanpratap Singh Kshatri, Amritha Suresh et al.· Journal of Basic and Clinica...· 0 citations
For decades, type 2 diabetes (T2D) pharmacotherapy has followed a reactive, stepwise approach, typically initiated with metformin monotherapy and intensified only after glycemic deterioration. This so-called wait-to-fail strategy may prolong hyperglycemia and increase the cumulative risk of microvascular and macrovascular complications. Early combination therapy (ECT) has been proposed as an alternative strategy to achieve faster glycemic control, improve glycemic durability, and enable timely use of glucose-lowering agents with cardiovascular, renal, and metabolic benefits. This narrative review examines the rationale for ECT in newly diagnosed T2D and summarizes evidence from landmark clinical trials. Recent updates to major international guidelines, including the 2026 American Diabetes Association Standards of Care in Diabetes and National Institute for Health and Care Excellence NG28, are also discussed, reflecting a shift toward individualized, comorbidity-focused treatment selection. While ECT represents an important evolution in T2D management, current clinical evidence supports its use mainly in selected patients rather than as a universal default strategy.
A. Janež, Tanja Smid, Manfredi Rizzo et al.· Journal of diabetes and its...· 0 citations
AIMS
Incretin-based pharmacotherapy was initially developed to improve glucose-dependent insulin secretion and glycaemic control in type 2 diabetes, but its clinical interpretation has expanded substantially with cardiovascular outcome trials, kidney outcome data, obesity studies and next-generation polyagonist development. This narrative clinical review uses structured literature identification and outcome-stratified synthesis to evaluate incretin-based therapies as cardiometabolic interventions across diabetes, obesity, cardiovascular disease and chronic kidney disease.
MATERIALS AND METHODS
The available evidence was interpreted according to therapeutic class, clinical domain, outcome maturity and safety boundaries, integrating clinical outcome evidence with receptor-network pharmacology.
RESULTS
Selected GLP-1 receptor agonists are supported by hard cardiovascular and renal outcome data, whereas several dual, triple, amylin-linked and oral small-molecule strategies are currently supported mainly by glycaemic, weight-loss, metabolic or early translational endpoints. This distinction is clinically important because treatment positioning should depend on patient phenotype, outcome maturity and safety boundaries rather than mechanistic plausibility alone. In patients with type 2 diabetes and established atherosclerotic cardiovascular disease, GLP-1 receptor agonists with proven cardiovascular outcome benefit should be prioritised when atherosclerotic risk reduction is a major treatment goal. In type 2 diabetes with chronic kidney disease, semaglutide has dedicated kidney outcome evidence. In obesity with cardiometabolic risk, high-magnitude and sustained weight reduction has become a clinically relevant therapeutic target. Receptor-network pharmacology, including GLP-1, GIP, glucagon and amylin receptor signalling, provides a useful explanatory framework for heterogeneous efficacy, tolerability and tissue-level effects.
CONCLUSIONS
However, clinical use remains bounded by gastrointestinal tolerability, lean-mass preservation, treatment durability, discontinuation effects and long-term safety. This review therefore proposes phenotype-based clinical positioning rather than a prescriptive treatment algorithm.
F. Sztanek, H. Lőrincz, M. Harangi et al.· Diabetes, obesity and metabo...· 0 citations
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