image: The anatomical and functional characteristics of non-culprit lesions can be assessed using intracoronary imaging modalities and fractional flow reserve to implement precision revascularization strategies. ACS patients are recommended to receive 1 year of standard DAPT, followed by a de-escalating regimen (eg, extended monotherapy) to balance ischemia and bleeding. High levels of cholesterol (especially elevated LDL-C) increase the risk of atherogenic coronary events. Statins, ezetimibe, PCSK9i, and siRNA therapy have been used alone or in combination to reach LDL-C targets with earlier, more intensive, and longerduration lowering. High-dose EPA may be a worthwhile add-on treatment, especially in statin-treated post-ACS patients with elevated TG levels. Lp(a) lowering agents will be part of future prevention. Inflammation is a common pathway in cardiovascular diseases, and anti-inflammatory treatment has emerged as a novel therapy. Abundant evidence has been accumulated on the effects of colchicine, but little on IL-1β or IL-6 inhibitors. Immune modulation with Treg-based treatment and alterations in gut microbiome profiling show promising results for managing residual risk post-ACS. ACS: Acute coronary syndrome; DAPT: Dual antiplatelet therapy; EPA: Eicosapentaenoic acid; hsCRP: High-sensitivity C-reactive protein; IL: Interleukin; LDL-C: Low-density lipoprotein cholesterol; Lp(a): Lipoprotein (a); PCSK9i: Proprotein convertase subtilisin/kexin type 9 inhibitor; QFR: Quantitative flow ratio; RIPK3: Receptor-interacting protein kinase 3; siRNA: Small interfering RNA; TG: Triglyceride.
Credit: Cardiology Discovery
Even with well‑executed standard secondary prevention therapy, many patients who survive acute coronary syndrome continue to face elevated chances of recurrent heart‑related complications. A new review published in Cardiology Discovery lays out a structured clinical framework to identify and manage residual cardiovascular risks for these high‑risk survivors.
While modern care for acute coronary syndrome, including revascularization, statins, and antiplatelet therapies, has lowered short‑term mortality, a notable share of patients still experience major adverse cardiovascular events months or years after their index episode. Persistent residual risk stems not only from vulnerable non-culprit lesions, but also from incomplete control of blood lipids, unresolved inflammation, thrombotic activity, and sub‑optimal lifestyle factors that standard treatment pathways may overlook. Clinicians lack unified practical guidance covering all these overlapping risk sources in post-acute coronary syndrome care.
In this narrative review, researchers from Chinese medical institutions consolidated recent guideline recommendations and high‑quality clinical evidence focusing on patients recovering from acute coronary syndrome. The authors grouped residual cardiovascular risks into four practical categories: non-culprit lesion instability, lipid‑associated residual risk, inflammatory residual risk, thrombotic residual risk, and modifiable lifestyle‑driven risk. They summarized existing therapeutic options including implementation of precision revascularization strategies by intracoronary imaging and fractional flow reserve assessment, newer lipid‑lowering agents, anti‑inflammatory therapies, optimized anti‑thrombotic regimens, alongside lifestyle modification and cardiac‑rehabilitation strategies for each risk subgroup. Rather than proposing one‑size‑fits‑all treatment, the paper emphasizes repeated risk re‑evaluation to support personalized clinical decision‑making for individual patients.
“Many post-acute coronary syndrome patients achieve basic treatment targets yet remain at substantial event risk,” said corresponding author Dr Weifeng Shen. “Clinicians need systematic thinking to detect these hidden residual risks and select appropriate add‑on interventions beyond baseline secondary prevention measures.”
This work is a narrative evidence‑synthesizing review and carries inherent limitations. It does not produce original patient‑level trial data; clinical decision‑making still needs to balance individual patient comorbidities, bleeding risks and drug tolerability. Prospective real‑world studies are required to further verify the clinical benefits of this multi‑dimension risk management workflow. Moving forward, the framework may help design better follow‑up protocols for acute coronary syndrome survivors in routine clinical practice.
The article “Optimal Management of Residual Cardiovascular Risks After Acute Coronary Syndrome” is available online in Cardiology Discovery, DOI: 10.1097/CD9.0000000000000201.
Journal
Cardiology Discovery
Method of Research
Literature review
Subject of Research
Not applicable
Article Title
Optimal Management of Residual Cardiovascular Risks After Acute Coronary Syndrome
Article Publication Date
7-Jul-2026